pandu kc008 gdg

“Evaluation of the effect of

Gudanagaradi Vati in Pandu”.

Thesis submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

In partial fulfillment of regulations for the Award of the degree of

DOCTOR OF MEDICINE

(AYURVEDA VACHASPATHI)

By

Iranna B. Kotturshetti

Guide Dr. Ch. Ranga Rao.

M.D. (Ayu) Professor and Head of the Department

Post Graduate and Research Center D. G. M. Ayurvedic Medical College, Gadag.

Co-Guide

Dr. Siva Rama Prasad Ketamakka. M.D. (Ayu)

Reader in Kayachikitsa Post Graduate and Research Center

D.G.M. Ayurvedic Medical College, Gadag.

POST GRADUATE AND RESEARCH CENTRE (KAYACHIKITSA)

D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG.

2001

Ayurmitra

TAyComprehended

This is to certify that Iranna B. Kotturshetti (M.D. (Ayurveda)

Kayachikitsa) has worked for his thesis on the topic entitled “Evaluation of the effect of Gudanagaradi Vati in Pandu”.

Cl inical tr ials are done under my supervision and

guidance. This thesis makes a dist inct advance on scienti f ic l ines

in the above subject and the f indings are highly signif icant at the

stat ist ical evaluation and have considerably contributed to the

present knowledge of the subject.

I am ful ly satisf ied with his or iginal work and hereby forward

the thesis for the evaluation of adjudicators.

Co-Guide

Dr. Siva Rama Prasad Kethamakka M.D. (Ayu) (Osm)

Reader in Kayachikitsa

Postgraduate and Research Center (Kayachikitsa)

D.G.M. Ayurvedic Medical College, Gadag.

This is to certify that the contents of this thesis entitled “Evaluation of the effect of Gudanagaradi Vati in Pandu”, has been worked out by

Iranna B. Kotturshetti under my supervision and close guidance and co

guidance of Dr. Siva Rama Prasad Kethamakka, M.D. (Ayu) (Osm).

This disease, Pandu was brought to light in Ayurvedic texts, the

etiology, pathogenesis etc., as advanced and explained by Iranna B.

Kotturshetti is solitary, scientific, and methodical and will definitely help in

explaining the disease in Ayurvedic parlance and further planning the

management.

This work is applied, scientific and an original contribution in the field of

research in Ayurveda.

I am fully satisfied with the work and recommend the thesis to be put

before the adjudication.

Guide

Dr.Ch.Ranga Rao M.D. (Ayu) (Osm)

Professor and head of the department Post graduation and research center

Kayachikitsa D.G.M. Ayurvedic Medical College, Gadag.

Index

Section I Introduction 1 -2

Section II Literary review 3 - 70

Historical

Shareera

Nidana

Contemporary Science

Chikitsa

Section III Material and methods 71 - 110

Drug review

Methods

Observations

Section IV Discussion and conclusion 111 - 122

Future Prospective 123

Summary 124

References

Bibliography

List of Charts

Chart number 1- Demographic Data of

“Evaluation of the effect of Gudanagaradi Vati in Pandu”.

Chart number 2A-1- Chief Complaints of


Chart number 2A-2 – Chief Complaints of


Chart number 2B – Chief Complaints of


Chart number 3 – Associated Complaints of


Chart number 4 – Nidana (etiology) of


Chart number 5a – Vatajadi lakshana of

“Evaluation of the effect of Gudanagaradi Vati in Pandu”

Chart number 5b – Vatajadi lakshana of


Chart number 6 – Assessment of


Chart number 7 Statistical assessment for the


List of Graphs Graph number - 1

Age incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"

Graph number - 2

Sex incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"

Graph number - 3

Occupational incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"

Graph number - 4

Economical status incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu

Graph number – 5

Diet incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"

Graph number – 6

Objective parameters at mean values in regular intervals Heamoglobin and RBC count

Graph number – 7 Objective parameters at mean values in regular intervals PCV and Serum Iron

Graph number 8 Result of the “Evaluation of the effect of Gudanagaradi Vati in Pandu"

List of Photographs

Photograph - 1

Guda

Photograph - 2

Nagara

Photograph - 3

Mandura

Photograph - 4

Tila

Photograph - 5

Pippali

ACKNOWLEDEMENT

I express my deep sense of gratitude to my respected guide Prof. Dr. Ch.

Ranga Rao M.D (Ayu) Head of department of Kayachikitsa, D.G.M Ayurvedic

medical college and post graduate and research center, Gadag. He has been very

kind to guide me in the preparation of thesis and for whose extraordinary efforts,

tremendous encouragement and most valuable thoughts provoking advice made me

to complete this work.

I am also grateful to my respected co-guide Dr. Siva Rama Prasad

Kethamakka, M.D (Ayu) (Osm), Reader in Kayachikitsa, PGARC, D.G.M Ayurvedic

medical college, Gadag, for patiently going through the draft of thesis and correcting

with precious remarks which have been very useful.

I am extremely thankful to Dr. G.B. Patil principal D.G.M Ayurvedic medical

college and post graduate and research center Gadag, for providing all necessary

facilities for this research work.

It gives me pleasure to expresses my gratitude to Dr. A.K. Panda, M.D (Ayu)

Lecturer, P.G. Department, D.G.M. Ayurvedic Medical College, Gadag. For being

kind and affectionate through his valuable suggestions and advisees as and when

approach.

I am very much grateful to Dr. M.C Patil, M.D. (Ayu), P.G. Lecturer, for his

valuable suggestions on the important subjects.

I wish to convey thanks to my respected lecturers, Dr. G.S. Hiremath, Dr. U.V.

Purad, Dr. C.M. Sarangamath, Dr. S.A. Patil, Dr. R.K. Gachchinamath, Dr. G.S.

Jukthihiremath, Dr. B.S. Patil, Dr. C.S. Hiremath, Dr. K.S. Paraddi, and other

lecturers of D.G.M Ayurvedic Medical College, for their help and suggestions during

my post graduation studies.

I sincerely thank my beloved classmates Dr. S.S. Hiremath, Dr. A.S Patil,

Dr.(Smt) Yashoda Mudigoudar, Dr. S.T Hombal, for their deep co operation and

involvement in the P.G study.

I am also thankful to all my post graduate colleagues Dr. B.M Mulkipatil, Dr.

R.Y.Shettar, Dr. J.I Hiremath, Dr. Suresh R.D, Dr. S.K Tiwari, Dr. C.V. Rajashekar,

Dr.Shyal kumar, Dr. Jayaprakash, Dr. Anil Kumar Bacha, Dr. V.N. Kulkarni and Dr. D.

Sitarama prasad, for their constant cooperation and help.

I am ever thankful to Prof. S.V. Sankanur for his constant moral support,

encouragement and help throughout my carrier.

I wise to convey my thanks to beloved Dr. Shashidhar Doddamani, M.D (Ayu)

and Dr. S.R. Hiremath, for their constant help and rational suggestions at this

research work.

I wish to convey my thanks to beloved Dr. Mallikarjuna A.S, Dr. M.S.

Hiremath, Dr. A.M Adi, Dr. D.G. Kolume for their cooperation.

I am ever grateful to respected Dr. S.B. Lakkol, Sri R.P Huilgol, Dr. R.N Patil,

Sri S.V. Kori and Prof. Siddu yapalparavi, for their encouragement and help

throughout my carrier.

I wish to convey my thanks to beloved shri V.M Mundinamani and Mr.S.B.

Sureban for supplying me essential references in the study. I m thankful to Mr. B.S.

Tippanagoudar, Lab technician, who extended his co-operation in investigations.

I thanks to Mr. P.M. Nanda kumar for his help in the statistical evaluate.

I am highly indebted to my beloved parents Smt. & Sri Basavanneppa

Kotturshetti, Sisters Lalitha, Akamahadevi, Sumangala, Ratna, and beloved brother

Shiva for their love and affection rendered throughout my carrier.

Thanks to all lecturers, physicians, house-surgeons, hospital staff, nurses and

non teaching staff for their timely assistance in completion of this work.

Let me express my thanks to all patients, those are on the trial for their

consent for enrolling in this clinical study and obedience to advises.

This list is incomplete with out remembering my beloved wife, Dr. Veena, who

helped in all respects to complete this valuable dissertation work.

Lastly I pay my deep homage and tribute to my former teacher late Prof. Dr.

V.V.S. Sastri for his selection of this valuable project.

Iranna B. Kotturshetti

Ayurveda is an ancient Indian medical science reminded by lord Brahma1.

The main aim of this Ayurvedic medical science is to protect the human beings from

various diseases following by rules and regulations of Swasthavritta and to have

disease free human beings to have healthy society2.

Disease is nothing but, life under altered conditions. These altered conditions

in fact manifest themselves through the agency of doshas, Dhatus and mala in the

body.

The present day unwholesome food habits are influencing deficiencies of vital

nutrients and leads to nutritional disorders. The disease Panduroga that is dealt in all

Ayurvedic texts with its treatment which is very much similar to Anaemia in later

Introduction 1

period. The Panduroga has very much similarity with Anaemia in later period. The

word Anaemia first appeared for medical use in 1824 and in 1849 it began to have a

specific medical meaning. It is one of the common clinical conditions both in the

developed and developing countries like India. The W.H.O has recognized as a world

health problem, which is much common in our country.

The disease Panduroga is explained in all most all Ayurvedic classics with its

etiopathogenesis and treatment elaborately. Ayurveda advocate the treatment of

Pandu with many herbal and herbo-mineral combinations. Charaka (C.Chi 16/72)

and Vagbhata ( A.H.Chi 16/25) have highlighted the combination of Guda, Nagara,

Mandura, Tila and Pippali, as an effective recipe in Panduroga that is named as "

Gudanagaradivati " in the present study.

The ingredients of Gudanagaradivati are easily available and chief from their

qualities and this prospective the study is being conducted to evaluate the effect of it

as a combination in Panduroga.

In this clinical study 25 patients were incidentally selected and subjected in

one group. The duration of treatment was 21 days.

The clinical and hematological assessment was made before and after the

study. In this study it was observed and analyzed the effect of Gudanagaradivati was

statistically significant. The hemoglobin concentration raised significantly and

response of clinical features of Pandu to the drug was good.

Introduction 2

1 Astanga Hridaya Sutra 1/3 2 Susruta Sutra 1/6

Introduction 3

Unlike the history of any other subjects the "History of medicine" is medicine it

self such a history at hand will serve as a golden key to the understanding of many

aspects of medicine in both academic and practical ways. The history of Ayurvedic

literature reveals more information regarding Panduroga.

In a systemic enquire into the state of medical science in India, it may be

pointed out that the Brihatrayi, were the earliest of the medical literatures. Which

furnish us with detail description of the disease Pandu, for the sake of convenience

the history of Ayurveda can be divided as follows.

1. Vedic period

2. Pauranika (Purana) period

3. Samhita period

4. Sangraha period

5. Modern period

1. Vedic period:

In Vedic literature especially in Rigveda3 and Atharvaveda4, we found the

terms "Halima" and "Harita" which are observed to be correlative with Panduroga.

The treatment of the said disease also mentioned in both the Vedas.

Review of literature 3

2. Purana kala:

The word "Pandu" is available in Mahabharata when sage "Vyasa"

intercourse with "Ambilika" the widow of Vichitravirya; she became quite pale (Pandu

Varna) with fear. That's why her son who born became pales (Pandu) coloured and

named as "Pandu".

In Garuda purana there is a reference that takra mixed with lauha churna was

advocated in the treatment of Pandu patient. Besides the above the description of

Pandu is also available in Agnipurana, Valmiki Ramayana, and Yogavasistha.

3. Samhita period:

The main Samhita like Charaka and Susruta have clearly described about

Panduroga. In Charaka Samhita Chikitsa sthana 16th chapter and in Susruta Samhita

Uttaratantra 44th chapter we can find about the description of Panduroga.

4. Sangraha period:

In this period - Astanga Sangraha, Astanga Hridaya, Madhava Nidana was

written and elaborated about Panduroga.

5. Modern period:

In modern period so many commentators discussed about Panduroga and

they co-relate it with Anaemia. The word Anaemia first appeared for medical use in

1824 and in 1849 it began to have specific medical meaning (which is much more

similarity with Panduroga).


Naming of the disease - " PANDU ROGA"

According to Ayurveda diseases are innumerable (aparisankhyeya) as

described by Charaka5. But they may be classified on the basis of rupa (main

complaints), Varna (alteration in colors), samuthana (according to etiology) sthana

(according to seat or location) and samsthana (according to clinical features of the

disease) and so on. There fore the Panduroga is such a disease rather clinical

condition characterized by alteration in colour of skin and mucous membrane.

Panduroga its definition and literature meaning:

When there is decreasing of Rakta (blood), Meda (fat), Ojas (body immunity),

diminished of body activities and discoloration of body occurs, at that time it is known

as Panduroga6.

When Ranjakapitta mixed with the first Dhatu i.e., Rasadhatu, it produces

Rakta Dhatu (blood), but when this process vitiated the vikara takes place and

ultimately Panduroga occurs7.

The word Pandu is a relative term to indicate some colour. With this purpose

Charaka had quoted in 24 places, Susruta in 29 places and Vagbhata in 14 places

have used the words like Pandu, Pandutwa, Panduta, Pandubhava, Panduvarna,


Pandura, Pandugatra, Panduvadan etc. in their classical text. Chakrapani, Dalhana

and Arunadutta, commentator of above Brihatrayee of Ayurveda had explained its

meaning as sweta, dhushara swetavabhasa and peetavabhasa.

Acharya Gangadhara has defined a Pandu Varna as 'Mlana' Varna to explain

the colour. Different colorful objectives like Shankha, Madanphala (ripe), Katakidhuli,

Parushakphala (unripe) etc. have been quoted. Monier William in his Sanskrit -

English dictionary has defined Pandu as pallor.

In Ayurvedic classic Pandu has been taken in three forms i.e.,

Pandu as a disease

Pandu as a sings symptoms (clinical features)

Pandu as a complication

But maximum part it considers as a disease due to change of the natural body colour

into abnormal colour and "Raktalpata" occurs.

The word Pandu is derived 'padi nashane dhatu' by adding 'ku' pratyaya in it.

The meaning of which is always taken in the sense of "nasham" and as Pandu has

been kept under the group which is classified and named according to the change in

colour. Therefore the nashana will be in the Varna or colour, which is further,

approved by Charaka with the word " vaivarna". Thus Pandu is a disease in which

there is mainly vaivarna or change in colour of the body takes place.


From various dictionaries, the term "Pandu" is defined as -

Pandu pittasamvalitah suklah - (Amarakosh)

Pandustu pitabhagardhah ketakidhuli sannibha -

(Vachaspatyam)

Panduh sretavarna, ketakidhuli sannibha, pitabhagardha varna

vedascha - (sabdastommahanidhi)

Pandu - pale white, whitish, pale, yellowish.

The pale white or yellowish white colour (the students sanskrit

English dictionary by Vaman Shivram Apte.)

From the above derivatives it could be concluded that Pandu denotes some specific

colour. "Roga " derived from (ruja + ghang) or "ruja karoti roga" - it means which

gives some pain is known as Roga.

As per students Sanskrit English dictionary;

Roga means - a disease, malady, sickness etc. So from above discussion we

could say that

Panduroga = the disease with pallor of the body.


3 Rigveda 10-50-11 4 Atharvaveda 4-9-3 & 1-22-2 5 Charaka Samhita Sutra 18/43 6 Charaka Samhita Chikitsa 16/6 7 Susruta Samhita Sutra 14/


In the process of genesis of Pandu pathology it is necessary to consider the

organs in concern. Specifically skin and blood, an admixture of plasma and blood

corpuscles has to be studied in detail. Lung, Liver, Spleen, and bone marrow also

have its impact on the genesis of pathology in Pandu. Here a stretch has been given

towards blood, as it is the specific cause of showing decreased haem and also total

blood cell (RBC) count along with Skin a covering and protective agent of the entire

body as it reflects the deficiency of blood in the body.

I. Twak

Vasa and shattwacha are the upadhatu of Mamsa Dhatu8, which are going to

develop in the process of dhatwagni paka of sequential progression of Dhatus the

Mamsa is said to be making the covering of the body9 and responsible for gati. The

skin (Upadhatu of Mamsa) is developed from Mamsa, show the characteristic

features in Panduroga as the twacha is being affected or showing the disease

significance in the skin, its importance is to be elucidated.

According to the opinion of Vagbhata embryological development of the skin

is from the blood i.e., Rakta as if from the boiling milk cream develops10. The skin is

having seven layers. At the present disease concern the first layer Avabhasini or

otherwise Udakadhara referred by Shalya and Kayachikitsa faculties respectively.

The shat twacha are as follows 11-

Literary review - Shareera 8

1. Avabhasini or Udakadhara

2. Lohita or Asrigdhara

3. Swetha or Sidhmakilasa sambhava

4. Tamra or Dadru Kusta sambhava

5. Vedini or Alaji vidradhi sambhavadhistana

6. Rohini

7. Mamsadhara

Avabhacini

This is the outer most and first layer of the skin. It reflects or shows the

colour of the second layer Lohita. As it reflects the colour it is presumed that the

colour change in Lohita is witnessed in Avabhasini. It is being said at the size of

1/18th of vrhee.

Lohita

Lohita looks in arunavarna i.e., red in colour and 1/16th of vrhee. It prevents

the blood flow to outside from the body. The colour of the blood in the lohita is

reflected through Avabhasini.

II. Rakta

Rakta i.e. blood is a liquid connective tissue, which is made of cells and

plasma and in further it is described as liquid intercellular substance. When freshly

shed, blood is a red, thick, opaque and slightly alkaline fluid. Out of its normal


functions as regular transportation, maintenance of Iron balance and acid base

balance are said to be specific.

Formation of Rakta

The essence of Ahara after being subjected to paka by Ranjakapitta attains

red colour and becomes Rakta Dhatu12. Susruta further says that the rasa is formed

from the Ahara rasa after reaching Yakrit and Pleha from the Kosta.

Now, coming to the point as to what the Rakta Dhatu may be in terms of

modern physiology, it can be said that the cellular portion of the blood is as Rakta

Dhatu and liquid part of blood is considered as Rasa Dhatu. Therefore, blood

includes both Rasa and Rakta Dhatu and for the convenience of description blood

can be referred to as 'Rasa Rakta'.

Blood cells

The cellular portion of rasa Rakta comprises 45%. The blood cells are of 3 types.

1. Erythrocytes or R.B.C.s

2. Leukocytes or W.B.C.s and

3. Thrombocytes or platelets.

R.B.C.s number about 5-6 millions/cu.mm diameter 7.7 microns and

Thickness of 2.2 microns. R.B.Cs do not contain nuclei while they are in circulation.

These cells enter the blood at bone marrow as and how they are produced and


matured in the red bone marrow. The rate of production of R.B.Cs by the bone

morrow is about 7 millions/second and the R.E. cells of the circulation will destroy

approximately the same number of cells. The red bone morrow gets stimulation for

the synthesis of materials required for the R.B.C production from the haemopoitic

factors present in the stomach, Brunner's glands of duodenum, liver, spleen and

R.E.F (Renal erythropoitic factor) of juxta glomerular apparatus. Apart from these

internal factors iron (Fe) copper (Cu), B12, folic acid and proteins of food serve as

extrinsic factors. By the influence of the above said factors hemoglobin is

synthesized in the body, and gets fixed to the R.B.C s. if the hemoglobin is not

synthesized well, the red bone marrow sends only premature R.B.Cs devoid of

hemoglobin.

Hemoglobin

The red colour of R.B.C s is due to the hemoglobin. This pigment is

composed of 2 substances viz. Heam and globulin heam contains prophyrin and Fe

(iron). Therefore the main component of hemoglobin is iron. This compound (Hb) can

combine with oxygen 60 times more than what the water can i.e., we are able to get

on with 6 liters of blood only due to the presence of this hemoglobin. If there had

been water instead of blood we would require 360 liters. Another advantages with Hb

are it can readily combine with O2 in the lungs and CO2 in the tissues and form the

unstable compounds, carboxy and oxy hemoglobin, and thus serving the oxygen

needs of the body with maximum quickness.

Quantity = 16 grams/100c.c. of blood in adults.


The life of R.B.C s is about 120 days. After this period since the R.B.C becomes

old and incapable to carry its functions, the R.E. cells of liver and spleen will destroy

such cells. The iron content of hemoglobin of these destroyed cells is mostly used

again for the synthesis of hemoglobin and part of it is spent for the production of bile

juice. If the destruction of R.B.Cs is increased more than normal, more of bilirubin will

be produced. And accumulates in the circulation resulting in jaundice (Kamala) the

hemolytic jaundice) the jaundice may also be caused by the damage of liver

(infective or hepatic jaundice) or by the obstruction of bile ducts (obstructive jaundice

- Avaruddha kamala). Thus the main functions of hemoglobin are.

1. To impart O2 carrying capacity to blood.

2. To impart colour to the body through blood.

3. To help again for the manufacture of Hb, and

4. To contribute some constituents required for the production of bile juice.

Functions of Rakta13

1 Varna prasada Colour of the skin

2 Mamsapusti Nourishment to other Dhatus like Mamsa

3 Jeevana vyapara O2 supply

4 Bala Strength

5 Sukha Health and happiness

6 Prasannata Tranquility

7 Ayuh Life


Suddha rakta purusha lakshanas14

(Characteristics of the person endowed with pure blood)

As long as a person is having pure blood in him -

His colour and complexion are very attractive.

His Indriyas and Indriyardhas are perfectly normal

His digestive power is perfect.

Will be quite healthy and happy.

His Dhatupusti and Bala are perfectly normal.

Suddha Rakta lakshanas15

The following colors indicate of pure blood.

Pure blood looks like a bright indra gopa

Like pure gold

Looks like Padma (lotus flower) and Alaktaka (lacca) and

Gunjaphala savarnam i.e. brightly red like Gunja seed

PANCHABOUTIKATA OF BLOOD16

The following qualities of blood represent the presence of their respective

Mahabhutas and thus establish the fact that the blood is Panchaboutika its.

1. Visrata = Fleshy odour indicates pruthvi bhuta

2. Dravata = Fluidity of out indicates jala bhuta.

3. Raga = Redness odour indicates agni bhuta

4. Spandana = Movement odour indicates vayu bhuta, and

5. Laghuta = Lightness odour indicates akasha bhuta.


Role of Phupphusa, Yakrit and Pleeha in Rakta Shodhana:

(Role of lungs, liver and spleen in the purification of blood)

Blood reaches the lungs through pulmonary artery from the right ventricle and

is distributed all around the pulmonary alveoli in lungs through the single cell walled

capillary net work. The alveolar wall also is extremely thin to facilitate the free

exchange of gases between the blood and air. Blood thus oxygenated in the lungs

passes on to the left atrium through pulmonary veins. Thus, the lungs are responsible

for the oxygenation of blood. Here, the CO2 of blood brought from the right side of the

heart gets eliminated through lungs during expiration and the O2 is taken in side by

the blood after inspiration.

SPLEEN:

The reticulo endothelial cells of the spleen destroy the old RBCs of the blood.

Bilirubin is formed out of the hemoglobin of the destroyed RBCs, spleen also helps in

the storage of blood.

LIVER:

Conjugation of bile pigments to form bile juice takes place in the liver.

Destruction of old RBCs takes place to some extent in the liver also by the Kupffer's

cells of liver. Moreover, as already described, the harmful substances like toxins,

bacteria, absorbed drugs etc., circulating in the blood are destroyed by the liver cells

and excreted through bile juice. The liver maintains the composition of blood.


COMPOSTION OF BLOOD

Cellular portion 45%

1 RBC"s 5 to 6 millions per c.mm.

2 WBC"s 6000 to 8000 per c.mm. and

3 Platelets 2 to 3 lakhs per c.mm

RBC, WBCm ratio: 1000: 1

RBC, platelets ratio: 20:1

Platelets WBC ratio: 50:1

Plasma 55%

Water = 92% proteins = 7%

Na, K, Ca, Mg, P, Fe, C etc. 0.9%

Non-protein nitrogenous substances -

Such as uric acid, Creatine, NH3 amino acid, neutral fat, = traces

The plasma proteins are

Serum albumin = 4.7%

Serum globulin = 0.4%

Fibrinogen = 2.2%

RAKTA KSHAYA LAKSHANAS17

1. Amla sishira preeti = desire for acrid and cold substances

2. Sirashaithilyata = collapse of blood vessels, and

3. Rookshata = dryness of skin


RASA VAHA AND RAKTA VAHA SROTASES18

The origin of Rakta vaha srotases is Yakrit (liver) and Pleha (spleen). The

above descriptions state that, the nutrients required for plasma and the storage of

blood take place in Raktavaha srotomoolas i.e., liver and spleen whereas the

pumping station for blood which as a basic nutrient supplier for all the Dhatus is

Hridaya along with its 10 dhamanis. These ten dhamanis cannot correctly be

described according to modern physiology. To correlate the number (10) we have to

take the important arteries like

1. Right and

2. Left coronary arteries

3. Inanimate artery

4. Subclavian artery and so on.

RAKTA SARA PURUSHA LAKSHANAS19

A person having fully developed Rakta Dhatu from the birth onwards is known

as Raktasarapurusha. His/her Karna (ears), Netra (eyes), Mukha (face), Jihva

(tongue), Nasa (nose), Oshtha (lips), Panitala (palms), Padatala (soles of the foot),

Nakha (nails), Lalata (fore head), Medhra (penis) etc., look brightly red glistening and

attractive.


8 Charaka Samhita Chikitsa 15/17 9 Astanga Hridaya Sutra 11/4 10 Astanga Hridaya Shareera 3/8 11 Susruta Samhita Shareera 4/3; Charaka SamhitaShareera 7/5 12 Charaka Samhita Chikitsa 15/27 13 Charaka Samhita Sutra 24/3 Susruta Samhita Sutra 5/6 14 Charaka Samhita Sutra 24/23 15 Charaka Samhita Sutra 24/21 16 Susruta Samhita Sutra 14/9 17 Astanga Hridaya Sutra 11/17 18 Charaka Samhita Vimana 5/9 19 Charaka Samhita Vimana 8/114


Literary review - Nidana 17

Factors, which are responsible for production of Pandu Roga, are clearly

mentioned by our Ayurvedic classics.

According to Charaka20

Intake of Kshara (alkali), Amla (acid) Lavana (salt), Ati Ushnata, virudha

Ahara, asatmya Ahara, Nishpava, Masha, Pinyaka, Tilataila, day sleep, excessive

exercise, Atimaithuna (excessive indulgence in the sexual acts), immediate alteration

of daily routine life, suppression of the natural urges (vegadadharan).

Human having excessive sexual willing, thought, fear, anxieties, anger,

person after taking the above etiological factors; his/her Pitta (Sadhakapitta which is

at heart) got aggravated and it mixed with vayu (Vyanavata) (which is more powerful

among the Tridosha). Than it makes "sthana sanshraya" within skin and muscle and

polluted Kapha, Vata, Rakta, Twacha (skin) Mamsa and create Pandu Roga.

According to Susruta21

Excess exercise, acidic and salty diet, madya (alcohol), mrit (soil), day sleep,

etc. - All these factors create Panduroga. Certain disease which act as causative

factor in the production of Panduroga (Nidanarthakar Roga) are -

1. Bleeding tendency diseases like - vividha abhighata, krimi roga (helminthic

manifestation), Arsha (piles), Rakta pitta, Rakta pradara etc.


2. Diseases of liver and spleen - Yakritdalyodar, Pleehodara,

(hepatospleenomegaly) Jalodar (ascities), Grahani (sprue).

3. Metabolic and other diseases like - Prameha, Raj-yakshma, Atimaithuna janya

Vyadhi (diseases because of excessive indulgence in sexual act), Visama jwara

(malarial fever), etc.

4. Pyogenic diseases like - Vrana, Arbuda (malignancy tumor).

5. Panduroga is also due to nidanarthakar roga - when some disease produce

another diseases are known as nidanarthakar roga. With this understanding

many diseases are found in Ayurvedic literatures, that precipitated Pandu,

possibly due to loss of blood from the human system. Examples are -

Raktarbuda22

Raktapradara23

Raktapitta24

Katika-taruna marmavedha 25

Raktakshaya26

Yakrit Pleha vedha27 etc,.

Various Ayurvedic Samhita describes the causative factors of Panduroga as

follows -

1. Ahara Hetu (Dietary factors)

2. Vihara Hetu (physical factors)

3. Manasika Hetu (factors affecting mind)


Samhita Ahara Vihara Manasika

Charaka28 Rasa Kshara Diwaswpna

Vyayama

Ativyavaya

Kama

Amla

Lavana

Guna Atiushna Prati Karma Chinta

Dravya Nishpav Ritu vaishamya

Vegadharana

Bhaya

Masha Krodha

Tila taila Shoka

Prinyaka

Susruta29

Madhava Nidana

Yogaratnakara

Rasa: Amla Diwaswpna

Lavana Ativyayama

Guna Atiteekshna

Dravya Madhya

Mrit


Purvarupa of panduroga

The sign and symptoms, which give the earlier idea about disease, which are

to be developed further, are called Poorvarupa that is prodromal symptoms of the

disease30. Acharya Susruta has described six stages of Kriyakala out of which the

forth stage of Kriyakala is sthanasamshraya represents the prodromal phase or

Poorvarupa of the disease.

In this stage the virgin doshas or dushyas are vitiated to the place in the body

where they suited place in khavaigunya and development of disease takes place at

that site.


Poorvarupa described by Brihatrai31

S.No Signs/Symptoms Charaka Susruta Vagbhata

1 Hrit Spandhana (palpitation) + - +

2 Rooksha (dryness) + - +

3 Swedabhava (No sweating) + - +

4 Shrama (Fatigue) + - +

5 Twak Sputana (cracking of skin) - + +

6 Hrillasa (Nausea) - + +

7 Pada gourava (Heaviness in lower limbs) - + +

8 Mridbhakshaneccha - + +

9 Akshi Koota shota (puffiness around eyes) - + +

10 Avipaka (Indigestion) - + +

11 Peeta mutrata (yellow urine) - + +

12 Peeta Purisha (yellow stool) - + +

13 Aruchi (loss of appetite) - - +

Purva rupa described by laghrutrayi Harita Samihita Vangasena32

Twak spotona

Sthevana

Gatrashoola

Mridbhaksanechcha

Prekshan kuta shoota

Purisha petata

Mutra petata

Avipaka

Akshikuta shotha

Shwayathu

Shareera panduta

Peta mutrata

Twak pradeeryata

Pipasa

Aruchi

Hrillasa

Urodaha

Anga gourava

Raktalochanata


Lakshana (Roopa) of Pandu

The term roopa implies both the signs and symptoms through which a disease is

identified. In addition to the cardinal signs and symptoms, a number of constitutional

symptoms will also manifest in Pandu. Few of the symptoms aid in distinguishing the

types on the basis of doshanubandha. In the advanced stage with deterioration of the

general condition, a number of other symptoms will develop. Accordingly the signs

and symptoms can be classified as follows.

1) Pratyatma lakshanas (cardinal signs and symptoms)

2) Samanye lakshanas (general signs and symptoms)

3) Vishishta lakshanas (distinguishing features of doshanubanda)

1. Pratyatma Niyata lakshanas

It is the invariable feature present in a disease Pandu Varna of the twacha is

considered as the pratyatma Niyata lakshanas of Panduroga. This is an abnormal

colour imparted to the skin due to rasa and Rakta kshaya in the body. This is almost

like colour of pollens of kethaki flower.

In addition to the above in vathaja Pandu krishna or arunavarna is associated

with Panduroga. In pittaja pandu peetha, haritha, haridra, likewise in kaphaja pandu

shwetha varna is associated with pandu varma and changes the normal colour of the

skin like krishna, shyama, avadatha, shymavedata to krishna pandutha, haridra

pandutha, shwetha pandutha etc.


2. Samanya lakshanas

A number of constitutional symptoms will manifest in varying degrees, which

are considered as general symptoms.

• Alparaktha

• Dourbalya

• Hridrava

• Shwasa

• Bhrama

• Kati uru and parshwaruk

• Karna kshewada

• Mandagni

• Sadana

• Gourava

• Shoonkshi koota

• Shotha

This is an important lakshana that can be observed in Panduroga. The

quantity of Rakta in whole body is stated to be about ashtanjali (eight anjali) and

Rakta Varna in its colour. Here guru and ushna gunas are on account of prithvi

dravatha due to Ap mahabutha. Rakthata is an account of tejo mahabhuta. Hence

this Rakta is attributed as Jeeva Rakta. Rakta imparts colour and complexion to the

skin and hence causes Pandu Varna.


Alpa Raktata

Alap raktata or Raktalpatha can also occur due to the kshaya of Rasadhatu

and Panduroga is grouped under rasapradoshaja vikaras. The kshaya of Rasadhatu

can be mainly due to two reasons, first being scarce availability of Ahara dravyas,

which are considered as basic requirements for the rasa prapthi. Any scarcity either

quantitative or qualitative results in rasaabhava owing to under nutrition and

malnutrition respectively.

The second reason, which can result in rasaabhava, is the vikruti of

Pachakapitta. Any vikruti in Pachakapitta results in the improper production of

Rasadhatu and in turn in the production of Rakta Dhatu depends on its previous

Dhatu the rasa.

Sometimes even though the production of Rasadhatu is proper any vikruti of

Ranjakapitta can also result in rakthalpatha as the process of rasaranjana is

impaired.

Along with Pachakapitta and Ranjakapitta the aganthu reasons like abhighata

can also result in rakthalpatha and in turn it may leads to Panduroga.

The conditions like Arshas, Pleehodara, Jeernavishama - Jwara, Raktharbudha,

Yakshma, Rakthapitta which result in Rakta nasha is also responsible for the

occurrence of Pandu. The disease Pandu that is resulted out of rasa and

raktakshaya can exhibit the following lakshanas.


1) Hridrava

2) Trishna

3) Roukshya

4) Shrama

5) Shosha

6) Glani

7) Daha

8) Sheeta pradhana

9) Krusha

10) Shwasa

11) Mandanala

12) Pandutha

13) Twak spotana

14) Dhatukshaya

15) Dourbalya

16) Gatrasada

17) Gurugatrata

18) Varnabeda

19) Nidralutva

20) Tandra

21) Shopha

Dourbalya

The extent of dourbalya in Pandu can be measured in relation to his normal

bala. The degree of rakthalpatha can also help in estimating whether dourbalya is

mrudu, madya or dharuna.

Karshya

Karshya in Pandu is related to the body of the individual in his healthy state.

Anyway the kshaya of poshaka dhatu such as Rasa, Rakta, Mamsa etc., can cause

the shushkta of the spik, greeva and udara. Dhamanijala will be prominent and

sthoolaparva may be present. The lakshanas appear as the vitiated Vata finds its

place in Raktadhatu.


Hridrava

Rasa kshaya and rakthakshaya result in Vata vriddhi cause Hridaya

spandana there will be an extra load on Hridaya as the hridayagati increases in order

to reach Raktadhatu to all parts of the body. This may ultimately result in Hridaya

visthara.

Shwasa

Shwasa in Pandu referred to the increases in the number of shwasa gathi this

is a common manifestation of dourbalya and many times indicated as Hridaya

dourbalya resulted out of extra load on Hridaya. This shramaja shwasa suggests the

prakopa of vayu and Kapha in general and prakopa of Pranavata in particular.

Bhrama

Any increase in rajoguna along with the prakopa of Vata and Pitta is

responsible for Bhrama. The vitiated Vata influencing Rakta, Mamsa and Medas

causes Bhrama. Pittavrutavata, ksheena kapha, ksheena majja, can also cause

Bhrama. Bhrama occurs due to the involvement of all these factors in Panduroga.

Kati, uru and pada ruk

The vrudha Vata of Panduroga is responsible for the pain in the above

regions.


Karnakshweda

It is a nanatmaja vikara of Vata. Due to Rakta Pitta the shravanendriya is not

nourished properly and due to alpamedaskatha, the snehanakriya does not takes

place, resulting in sthanika rooksha guna vriddi and vitiated vayu takes shelter in

karna to lead to karnakashweda.

Mandagni

Mandagni is due to rakthalpata. This is due to the vitiated Pitta, Kapha and

also due to the influence of vayu over koshtagni.

Sadana

Avayavasadana is a nanatmaja vikara of Pitta dosha, Mamsa Dhatu

ksheenatha and ojoksheenatha are mainly responsible for causing sadana in the

body so we can say sadana in Pandu is due to Dhatu kshaya and ojokshaya.

Gourava

It is due to the increased Kapha dosha and Ama dosha in the body. In

Panduroga this occurs due to Agnimandya which results in the formation of Ama that

causes the Dhatu shaithilyatha in the body.

Shoonakshikoota

Occurrence of shotha in akshikoota is due to rakthalpata in Panduroga. This

is again due to the increase in Amadosha.


Sheernalomatha

This is due to increase of Vata and Pitta in the body. Due to rakthalpata other

Dhatus will be undernourished due to which sheernalomatha occurs.

Hathaprabha

This is due to the causes like raktalpatha and Pitta prakopa. Rakta Dhatu and

Pitta prakopa are responsible for imparting colour and complexion to the body. The

person of Panduroga suffers from the loss of complexion due to ojokshaya in the

body.

Shwetaakshitwa

This is explained by kashyapa under the heading of samanya lakshanas of

Panduroga. This is due to increased vayu and majjagatha Kapha vikruthi.

Shwethanakhatwa

This is due to the rakthalpata and vitiated Kapha in the body.

Satwahani

The word satwa denotes 'bala' so satwahani means balahani. Dhatu shaitilya

and agnimandya leads to mal nourishment and satwahani. Satwa also signifies

Manas, so the involvement of Manas in Pandu is also significant. The satwa amsha

of Manas is deteriorated due to Ojokshaya in the body.


Tabular form of Pandu Lakshana

S.No Lakshana Charaka Susruta Vagbhata 1 Karnakseweda + - + 2 Hatanala + - + 3 Dourbalya + - + 4 Sadana + - - 5 Annadwesha + - + 6 Shrama + - + 7 Bhrama + - + 8 Gatrashoola + - - 9 Jwara + - + 10 Swasha + - - 11 Gourava + - + 12 Aruchi + - + 13 Gatramardata + - + 14 Gatrapeeda + - - 15 Gatronmatana + - - 16 Soonakshikoota + - + 17 Harita varna + - Panduvarna 18 Sheerna lomata + - + 19 Hata prabha + - - 20 Kopanata + - + 21 Shishira dweshi + - + 22 Nidraluta + - - 23 Pindikodweshtana + - - 24 Katiruk + - - 25 Pada ruk + - - 26 Pada sada + - - 27 Ururuk + - - 28 Kati sada + - - 29 Uru sada + - - 30 Dhatu saithilya + - + 31 Ojo guna kshaya + - + 32 Alpa raktata + Raktadusti + 33 Alpamedaskata + - + 34 Nissarata + - + 35 Hridrava + - + 36 Sithilendriyata + - + 37 Twacha panduta + + + 38 Swetakshitwa - - - 39 Sweta nakhatwa - - - 40 Swetha vakrata - - -


3. Vishista roopas

The lakshanas specified to doshic virulence is also an important part of their

study, for the early diagnosis and for the purpose of prognosis. The different

classification of Panduroga is mentioned with reference to samanya Samprapti.

Classification of Panduroga

According to sankya Samprapti the classification of Panduroga described in

different Samhita granthas in different views. Charaka, Vagbhata, Madhava,

Sharangandhara, Yogaratnakara and Kashyapa all mentioned 5 types of Panduroga.

They are as follows33.

1.Vataja

2.pittaja

3.kaphaja

4.sannipataja

5.mritbhakshanajanya

Susruta has claimed that there are only 4 types of Panduroga34

1.vataja

2.pittaja

3.kaphaja

4.sannipataja

According to Susruta different types of mrit produces particular

doshavaishamya or doshaprakopa and afterwards gets converted into doshaja

Pandu. Hence he has not included the mritbhakshanajanya Pandu as 5th type of

Panduroga.


Taking in to consideration all these opinions we can say that there are 5 types

of Panduroga as described by Acharya Charaka and Vagbhata.

Vathaja Panduroga

As said earlier the prevalence of vathaja Panduroga is in those who are of

vathaja tendency. Hence in this the colours like krishna and aruna are associated

with Panduroga.

Due to the vitiation of Vata the person suffers from kampa, parshwashoola,

shirogourava etc., apart from the above features we can also note some other

features in vathaja Panduroga like nakhachippitathe, nakhabhangrurathe etc.,

Pittaja Pandu:

Pittaja Panduroga occurs to those who are usually of pittaja tendency where

severe aggravation of Pitta is present.

Kaphaja Pandu lakshana

Kaphaja Panduroga usually occurs in those persons who are usually of

kaphaja tendency. Here Kapha will be severely associated with Pitta dosha resulting

in the causation of Panduroga Kapha will be aggravated in Dhatus and vitiates

mainly rasa and Rakta resulting in Dhatu shaitilyatha. This further leads to conditions

like balakshaya, sneha kshaya, Varna kshaya and ojokshaya.


Showing the lakshana of vataja Pandu35

S.No Lakshana Charaka Susruta Vagbhata

1 Krishna panduta + - -

2 Krishna nakatwa - + -

3 Aruna nakatwa - + -

4 Krishana Akshitwa - + -

5 Krishna siratwa - + -

6 Shrama + - +

7 Rookshangata + - -

8 Arunangata + - -

9 Rukshanetrata - + -

10 Angatoda + - +

11 Angamarda + - -

12 Kampa + - +

13 Parshwaruk + - +

14 Shiroruk + - +

15 Asyavairasya + - +

16 Shofa + - +

17 Balakshaya + - +


Showing the lakshana of Pittaja Pandu36


1 Gatrapeetata + - +

2 Harita + - +

3 Peeta sira - + +

4 Jwara + + +

5 Daha + - +

6 Trishna + - +

7 Chardi + - -

8 Sweda + - +

9 Amlodgara + -

10 Dourabalya + -

11 Peetomutrata + +

12 Shosha + -

13 Peeta vitkata + +

14 Binna varchastva + -

15 Shopa - -


Showing the lakshana of Kaphaja Pandu37


1 Shwethavabasatha + -

2 Shuklakshita - + +

3 Shuklanakataha - + +

4 Shuklananathva - + +

5 Gourava + + +

6 Moorcha + - -

7 Bramaha + - -

8 Shwasa + - -

9 Alasya + - -

10 Shwayathu + - -

11 Shuklamootratva + + -

12 Shuklavarchaskatha + + -


Sannipathaja lakshana

If the vitiation of all the dosha is equally severe then it may be resulting in

tridoshajnya Panduroga. This causes severe degree of Dhatu shaitilyatha and

dhatugourava from which deterioration of Dhatu and Ojas occurs very rapidly. We

can find the features of sannipataja Panduroga in Harita Samhita only. Others have

sated the manifestation due to the degree of variations In the doshic imbalance, this

Panduroga considered as Asadhaya.

Tridoshajanya Panduroga lakshanas as stated by Harita38 -

1) Tandra

2) Alasya

3) Shotha

4) Vamana

5) Kasa

6) Hrullasa

7) Shosha

8) Vitbadha

9) Parusha

10) Jwara

11) Kshudarta

12) Moha

13) Trushna

14) Klama

Mritbhakshanajanya pandu lakshana39

A separate or a unique explanation of this condition is seen in Charaka

Samhita. Susruta has included this condition is sannipathaja Panduroga only.

Mritbhakshana or consumption of mud or soil is a peculiar condition in which it

causes Panduroga only. That is why Vijayarakshitha has quoted this instance of

occurrence of Panduroga due to mud eating and here soil eating is to be considered

as Vyadhi karana. Consumption of soil vitiates all the three doshas in the body. If the

soil is kashayarasa, then the increase of Vata can be observed. Like wise if it is

katurasa then of Pitta or if it in madura rasa then the increase of Kapha can be

observed in the Panduroga.


1) swatantra Panduroga. Where the condition has appeared as a specific

disease entity, and

2) paratantra Panduroga where the Pandu appears as a clinical feature or

complication of other disease like pittija pratisyaya, pittija kosha, pittarsha,

pittija promeha, grahani krimi roga, sosha, etc.

Table for classification of Pandu in different Samhita

S.no Name of the Pandu CS SS AH AS BP VS MN HS

1 Vataja + + + + + + + +

2 Pittaja + + + + + + + +

3 Slesmika + + + + + + + +

4 Sannipataja + + + + + + + +

5 Mridvakshanaja + - + + + + + -

(CS = Charaka Samhita, SS = Susruta Samhita, AH = Astanga Hridaya,

AS = Astanga Sangraha, BP = Bhava Prakasha, VS = Vanga sena

MN = Madhava Nidana, HS = Harita Samhita)


Samprapti of Pandu and its co-relations

Ayurveda believes in the doshika theory for creation of any type of disease

according to our classics there is three dhosas namely Vata, Pitta and Kapha in our

body. As long as these doshas (humors) are in complete harmony, body is in normal

condition and as soon as they imbalance, any kind of disease is produced40. This

imbalance state is usually because of the vitiation of a particular dosha or in

combination of other, leads to the production of disease, is known as Samprapti.

According to Vagbhata Samprapti is the process of the disease, which deals

with the process of vitiation of doshas, which spread all over the body and with the

manifestation of the sign and symptoms of a disease. Thus the study of the entire

changes taking place in the body under the influence of the etiological factors leading

to production of disease is known as "Samprapti"41. It deals with the body changes

both in the clinical as well as sub clinical stages of the disease.

According to Charaka, due to intake of Pitta prdhana tridosha prakopak Ahara

and Vihara, the Pitta (Sadhakapitta) which is situated in the heart is excited and this

excited Pitta throws away from the heart via ten dhamanis with the help of vitiated

vayu. Then it wanders through out the whole body and finally takes

(sthanasamsraya) in the space between skin and muscle and they're by vitiating

Kapha, Vata, Rakta, Twak and Mamsa and producing Pandu varna (pale coloration),

haridra varna (deep yellow colour), Harita varna (greenish colour), etc. the skin42.


Samprapti according to Charaka in summarized form43

Pitta pradhan tridosha prakopak nidan sevan

Agni vikar and rasa dusti

Dosha prakopa (mainly Sadhakapitta inside heart)

Prasara via srotas by vayu

Dhatu dusti (vikriti)

Dhatu kshaya (raktalpata)

Panduta (discoloration of skin)

Susruta has distinctly subdivided the entire process of the production of disease

in to six stages and has termed as " shat Kriyakala". These stages have importance

from both diagnostic and treatment point of view. These six stages of progression of

pathology are44 -

sanchaya (accumulation)

prakopa (excitation)

prasara (spread)

sthana samsraya (localization)

vyakti (manifestation)

veda (complication)


Sanchaya:

In Panduroga due to excessive intake of paittika Ahara - Vihara, the Pitta

dosha will be vitiated which accumulates in its chief site i.e., Amashaya. Here this

person may develop mild symptoms in the form of ichha and dwesha, which means,

he may like the sheeta and madhura dravyas and dislikes ushna and tikshna

dravyas. If person recognizes these instincts (likes and dislikes) and acts accordingly

the dosha will come back to their normal condition, on the other hand if they are not

recognized and the patient continue to indulge in Pitta vardhak Nidana; the doshas

increase again.

Prakopa:

In Panduroga due to continuous indulgence of paittika Ahara - Vihara, the

Pitta dosha increase further and spread to many of their own sites like Yakrit, Pleha,

twaka, drika etc. and produce its own specific symptoms in all places. These are

moderate in nature, the person feels that he is not well but goes about his daily

routine. He can easily get over this abnormality by suitable adjustment in foods,

activities and simple drugs and remedial measures by consulting physicians.

Negligence in appropriate action leads to the next stage of abnormality.

Prasara:

In Panduroga excited Pitta dosha enter in to the Hridaya (Hridaya

samvasthitam) by leaving its original sites i.e. Yakrit, Pleha, twak etc. after reaching

Hridaya, this excited Pitta dosha spread to all over the body through dhamanies with

the help of vayu. Here the person develops some powerful symptoms. If effective


treatment become available the doshas will come back to normal. If the person

continues to indulge the same etiology, or if treatment is ineffective, the abnormality

continues further to the inset of the fourth stage.

Sthanasamshraya

The fourth stage of Kriyakala is also as Sthanasamshraya. At this stage

dosha - doosya samorchhana occurs. The increase doshas, which were higher to

travelling all over, the body mixed with the circulating rasa Dhatu. Now tend to

localize in the particular tissue, organ or system because of early symptoms of the

specific disease start manifesting

Vyakti:

This is the stage of full manifestation of specific disease with all its

characteristic of specific disease with its entire characteristic sign and symptoms. In

case of Panduroga, after the localization of vitiated Pitta dosha in between twak and

Mamsa, the specific sign and symptoms of Pandu like pale yellow and greenish and

different types of discoloration of skin develops.

Bheda:

In this stage the body forces may arrest the pathological process and disease

may subside or it may be passed to sub acute or chronic stage or stage of

complication may begin.


Co-relation:

Vatika Pandu:

Although Pitta plays main role in the development of Pandu but Vata dosha is

also vitiated in the process of pathogenesis. It acts along with Pitta on the Rakta

Dhatu, so that they absorb fluid portion of the cell and as a result cell assumes

smaller size. Thus the vatika Pandu may be correlated with the microcytic anemia

and other anemia's having disorders in the shape of RBC like sickle cell anemia.

Paittika Pandu:

In this type of Pandu, there is a disturbed metabolic activity of the

erythrocytes due to increased metabolic activity. So there is no proper formation of

blood and on the other hand there is accumulation of waste products (mala

Sanchaya). Thus in patient of paittika Pandu, there is increased haemolysis due to

break down of R.B.C. as Pitta is predominantly acting on the Rakta so there is more

and more haemolysis. Hence the size of red cell and hemoglobin concentration is

same but the number of red blood corpuscles remains low. So the paittika Pandu

may be correlated with normocytic anemia.

Kaphaja Pandu:

Kapha and Pitta are antagonistic to each other, one being of sheeta guna

other of ushna guna. Thus the sheeta quality of Kapha is neutrialized by ushna guna

of Pitta. In Kapha fluid portion is more, hence more and more fluid is absorbed by the

cell and assumes large size. Therefore kaphaja Pandu may be correlated with

macrocytic anemia.


Sannipataja Pandu:

When all doshas are involved and act together, naturally it will produce

different types of cells. When there will be more activity of Kapha, the cells assume

large size and when Pitta activity is more, the cells remain normal and when Vata

activity is more, it assumes smaller size. So there will be anisocytosis and

polikilocytosis. This type of pandu may be correlated with mixed type of anemia

having dimorphic picture.

Mrid bhakshana janya pandu :

In this condition any of the three doshas may be vitiated according to nature

of the clay and doshas when vitiated will produce corresponding types of Pandu.

Ayurveda Nidana Chikitsa ka sidhanta by prof. R.H. Singh, it is clearly

mentioned that after eating of Mrit (soil) the worms are created in side abdomen and

hamper the absorption of the nutrition's and ultimately iron deficiency anemia.

Modern medical science also believe that pica (i.e. eating of clay) is the one of the

major factor for iron deficiency anemia45.


Factors of Samprapti

I. Dosha

a. Pitta dosha -

Pitta is the chief factor responsible for Panduroga. Before explaining the

pathological process of the doshas it is ideal to briefly know its physiological function

in the body.

Generally Pitta dosha is responsible for various functions like vision

(darshana), digestion and metabolism (pakti rushma), appetite (kshut), thirst

(thrishna), unctuousness (deha mardava), complexion (prabha), intellectuality (meda)

etc.,

Pitta dosha, which is situated in the Amashaya, is responsible for nourishing

and regulating the subsidiaries like Sadhakapitta, Ranjakapitta, and Alochakapitta

and Bhrajakapitta. These varieties have their definite and specific actions in the body.

In Panduroga Pitta dosha attain morbidity due to Nidana sevana. There at

first the Pachakapitta is the target of morbidity and this morbid and increased Pitta

transforms the poshaka rasa into the state of amavastha and circulates all over the

body along with it, in this process it vitiates other Pitta and other doshas etc.

The Pachakapitta which itself is excited and morbid fails in its own functions

and also in the nourishment of other Pitta in the body. The process of digestion is


suffered and metabolism is impaired. The desire for the food is lost, the thirst

increased, the complexion is changed and the intelligence interfered.

It may not be out of place here to mention that the modern medicine

postulates the importance of castle intrinsic factor in the absorption of vitamin B12 (an

extrinsic factor). Which is essential for the synthesis of erythrocytes that is from the

proerythroblastic phase. This intrinsic factor is present in the gastric mucosa and in

the normal gastric juice. This is an enzyme like unidentified substance secreted by

stomach.

The factors responsible for the erosion of gastric mucosa and for the altered

pH of gastric juice may lead to the absence of intrinsic factor leading to pernicious

anemia.

In Ayurveda the highest importance is given for the maintenance of

Jatharagni which in other words can also be called as Pachakapitta. If this Pitta is

normal then the digestion and metabolism of the food material is proper. If this

paktirushma is disturbed due to various extrinsic factors like consumption of madya,

katu, rooksha, teekshana aharas leads to the khavaigunya in the Amashaya. Due to

the above cause the walls of Amashaya (gastric, mucosa) is impaired due to

khavaigunya in the Amashaya, the Ahara rasa will not be digested and absorbed

because it attains Ama roopa. In this context we can quote the reference of

chakrapani who mentions "raktaposhaka sarabhaga anutpadana" or the non-


production of Rakta poshaka rasabhaga in the Amashaya is one of the chief cause of

Panduroga.

As explained earlier the remaining Pitta like Sadhaka, Ranjaka, Brajaka get

involved in the causation of Panduroga. The Ranjakapitta, which is situated in Yakrit

and Pleha, is responsible for the coloration of Rasadhatu. The Yakrit and Pleha are

the seats of Raktavaha Srotas vitiation of Ranjakapitta leads to the impaired

coloration of Rakta Dhatu.

The modern physiology says that the bile pigments and the chlorophyll are

necessary for the hemoglobin formation. The two chief constituents of bile pigments

are billirubin and biliverdin, which is present in bile. The old and worn out RBCs

disintegrated and they are removed from the circulation through the cells of reticule

endothelial system. The bone marrow appears to be the most active site.

Hemoglobin is released by the degradation and is broken into amino acid, which

enters the general amino acid pool In the formation of new hemoglobin. The rest of

the haem is converted into yellow pigment.

The deficiency of bile pigment and chlorophyll leads to the loss of hemoglobin

formation and therefore leads to hypo chromic anemia.

As said earlier the mala of Rakta is known to be Pitta. Though it is very

difficult to establish this malaroopa Pitta as bile itself, yet basing on the available

references we can say that bile is one of the chief constituents of Rakta Dhatu


(RBC's) which are old and damaged. These are disintegrated in Yakrit and Pleha and

are broken down. If the Pitta is provoked in Yakrit and Pleha then again the

malaroopa Pitta is increased and these may ultimately interfere in the formation of

Rakta through rasa ranjana, where bile pigments are affected and ultimately cause

Pandu or hypo chromic anemia.

After the vitiation of Pachakapitta and Ranjakapitta the next target is the

hridistita Sadhakapitta. Due to alpa raktata the Hridaya which is responsible for the

circulation is strained and the cardiac effort will be increased. Due to this the

Sadhakapitta is influenced by the vitiated Rakta and is circulated all over the body

and locates in vitiated twacha and Mamsa, when Sadhakapitta is vitiated and located

between twak and Mamsa is further influenced on Bhrajakapitta of twacha. The

Bhrajakapitta, which is already, affected from the lack of nourishment (due to

Pachakapitta vitiation) its functions like prabha and Varna are interfered leading to

Pandutha of the skin.

b. Vata dosha

The vayu is the chief factor in the body for initiation of all the activities.

Vitiated vayu is responsible of the expulsion of Sadhakapitta from Hridaya to dasha

dhamanies. Here vayu is responsible for manifestation of various signs and

symptoms due to Dhatu kshaya and margavarodha. In the pathogenic process

Samanavata may play an important role in the vitiation of Pachakapitta likewise due

to rakthalpata Vyanavata may be increased in the body and this further increases the


cardiac effect and the function of Hridaya impaired. On the causation of vathaja

Pandu Charaka mentions the person who consumes the food materials which

provoke Vata may suffer from vataja Pandu by manifesting the signs and symptoms

like rookshatha, angamarda, kampa, parshwaruk, shotha, balakshaya and krishna

pandutwa. The prevalence of vathaja Pandu is seen in those who are known to be of

vathaja tendency.

c. Kapha dosha

The role of Kapha in Panduroga is again to be discussed on the basis of the

association in this disease, Kledakakapha and Avalambakakapha are the chief

factors for the causation of Panduroga.

Incase of kaphaja Panduroga Charaka mentions some of the important

features like shwasa, kasa, aruchi, vakgraha, brama, klama, moorcha. The

prevalence of kaphaja Pandu is more in those persons of kaphaja tendency.

II. DOOSHYAS

a. Rasa

It is interesting to know the involvement of Rasadhatu in the occurrence of

Panduroga. Physiologically the function of Rasadhatu is attributed to nourishment

(preenanam) and also helps nourishment. If this Dhatu is efficient then it is not only

nourishes itself, but also helps to nourish the other Dhatus of the body. And its

upadhatus like twacha and Lasika. In case of Panduroga rasa Dhatu is basically


influenced by the vitiated Pitta dosha and attains the amaroopa due to coming in

contact with the amaroopa poshaka rasa. In this stage instead of its normal functions

of Rasadhatu results in the form of Dhatu shaitilya, from which the integrity in the

functions of rasa Dhatu and other Dhatus will be lost and later results in Shareera

gourava. This ultimately fails in the nourishment of twacha and may result in

rookshatha and vaivarnya.

b. Rakta Dhatu

In fact the Dhatu that has direct bearing with Panduroga though in the earlier

reference it is mentioned that Rasadhatu is involved. The function of rasa ranjana is

interfered in the raktavaha srothamoola i.e., Yakrit and Pleha. The result of the

interference is alparakata, nissarata, vaivarnyata, indriya shaitilyatha in the body. The

Rakta alpata either may be directly due to the involvement of Yakrit and Pleha or

indirectly it is affected due to the failure mechanism of Jatharagni. At this juncture the

importance of Pleha in its subtle control over the bone marrow in the RBC formation

is to be noted.

III. The role of Agni

The independent study of Agni is equally essential for the study of Panduroga. It

is of 4 types -

1. Doshagni

2. Jatharagni

3. Dhatwagni

4. Panchabhootagni


1. Dhoshagni

The Pitta doshagni is responsible for complexion digestion and metabolism in

the body at different levels. The Agni constituent of Pitta dosha is severely impaired

due to which the doshas is impaired in the body leading to increased amaroopi dosha

in the body.

2. Jatharagni

This is basically, impaired in the body resulting in the formation of Ama. This

is directly responsible for Pandu due to khavaigunya in Amashaya and has indirect

influence on other Agnis to cause Pandu due to Ranjakapitta dushti.

3. Dhatwagni

The dhatwagni especially rasa dhatwagni and Rakta dhatwagni are impaired

due to amaroopi poshakarasa. Hence the twacha loses its integral functions. Rakta is

deteriorated in its functions in the body.

4. Panchabhootagni

The tejamsha of the tejo mahabhoota is interfered in Pandu and the ap-

bhutagni is associated with it. As the tejoagni is impaired the digestion and

metabolism, the complexion of the body is impaired. In the due course the ap-

bhootagni is associated due to which the person may suffer from shotha.


IV. Ama

The non-homologous undigested substance can be called as Ama. In

Panduroga, the Ama may be formed due to the impairment of Jatharagni, doshagni

and dhatwagni etc.

V. Srotas

The important srotas, which are involved in panduroga, are -

1) Rasavaha srothas

2) Rakthavaha srothas

1. Rasavaha srotas

Here the Hridaya is involved along with dasha damanies and the functions of

this is impaired leading to various signs and symptoms.

2. Raktavaha srotas

The Yakrit and Pleha are the chief organs involved in Panduroga where

Ranjakapitta is vitiated.

VI. Pandu as Rasa pradoshaja vikara

Both Charaka and Susruta considered pandutwa and Panduroga in

rasapradoshajavikara. Before explaining the rasapradoshaja vikaras, Charaka has

told that the vikaras are caused by the vitiated doshas, which affects the rasadi

dhatus. Apart from this in the context of graham while explaining amothpatti he has

told that when rasadhi dhatus are affected by Ama dosha it leads to rasaprdoshaja


Vyadhi while commentating on the word 'rasadoshaja' told by Susruta, Dalhana says

that -

"rasadoshaja iti doshadushitha rasajathna"

It means the disease produced by the vitiated doshas that affects rasa.

So the disease Pandu is included in rasa pradoshaja Vyadhi because it is

manifested due to the vitiation of rasa Dhatu by vitiated vatadi doshas and Ama

dosha.

The Panduroga lakshanas explained in the classics are almost similar with

that of dhatukshaya lakshanas. By this it is evident dhatukshaya leads to Panduroga,

because through rasa dhatu other dhatus are nourished. Here in Panduroga

dhatukshaya may occur after the manifestation of the disease not only directly Rakta

and its srotases involves in this diseases but also other srotases such as rasa,

medhas, etc., when they are under diminished condition gives rise twak roushyata,

etc.,


Upadravas of Panduroga46

Roga arambhaka dosha prokopajanya vikara is known as Upadrava of that

particular disease. Any factor which is early part causes development of disease, if

the same factor is later part produces any other severe manifestation then it is called

as Upadravas (complications), in Ayurvedic classics the various complications are

available. These are aruchi (anorexia), jwara (pyrexia), pipasa (thirst), agnisada

(maldigestion), moordha jura, chhardi (vomiting), murchha (fainting), abalatwa

(weakness), shotha (oedema) klama (nuresthenia), hridayawapidanam (pre-cardial

pain), kasa (cough), shoola (pain), avipaka (improper digestion), atisara (diarrohea),

daha (burning sensation) swarabheda (obstruction of speech), shwas (dyspnoea).

The symptoms are described above when aggravated require special

management but few of them usually may be more important and require more

attention.

Moordha ruja - It is due to increased Kapha and Vata. When there is lack of blood

formation due to dysaemopoiesis. It is like sub acute combined degeneration as

obtained in pernicious Anaemia.

Murchha - It is due to increased activity of Pitta. There is more and more blood

destruction and in turn fainting (murcha) may develop.

Hridayawapidanam - It is due to excessive loss of rasa and Rakta. Heart has to

perform more activity for the compensation of the blood supply of the whole body. If


this condition is continued for long time, the heart may be dilated and this may

develop the symptoms of precordial pain.

Shotha - Due to loss of blood, there is hypoproteinaemia which in turn may produce

shotha (oedema).

Kasa - It is due to the loss of blood and increased activity of Kapha, because of it

kasa may develop.

Atisara - It is due to aruchi (anorexia) and avipaka (improper digestion) atisara may

develop.

Swasa - Due to severe loss of blood, there is anoxia, which simulates the respiratory

center, and breathing is increased.

Daha (burning sensation) - It is due to diminution of rasa and Rakta and increased

activity of Pitta, symptoms of daha may develop.

Prognosis of Pandu (sadhyasadhyata)

The disease Pandu leads to balakshaya and person becomes nihsar. So the

body immunity of the person is reduced. If the disease is severe and untreated it may

be fatal.


Sadhya - Asadhyata of Panduroga47

Sadhya lakshana

1. Diseases which are caused with less causative factors

2. Which are created with unequaled in nature in dosha and dushya, dosha and

prakruthi, dosha and kala, dosha and dushya.

3. Which is situated in any one out of shaakha, marma asthi sandi and koshta.

4. Which is new and without any complication

5. Which arises from one dosha

6. The patients body which is capable of taking all kinds of medicine.

The above features are considered to be sadhya for the management of Panduroga.

Asadya lakshanas

1. A chronic Shotha in a due course in whom the eyes are looking peethabha.

2. A chronic and deteriorated person

3. The person who is suffering from Atisara or who is passing stools with Kapha and

is haritha in its colour.

4. The person who is suffering from severe degree of pallor due to Rakta kshaya.

5. The person who is suffering from Chardi, Moorcha

6. Occurrence of Shotha in the dependent parts

7. Occurrence of Shotha in the abdomen


20 Charaka Samhita Chikitsa 16/7-8 21 Susruta Samhita Uttara 44/3 22 Susruta Samhita Nidana 11/17 23 Susruta Samhita Shareera 2/21 24 Charaka Samhita Chikitsa 2/27 25 Susruta Samhita Shareera 6/27 26 Harita Samhita 3-9-39 27 Susruta Samhita Shareera 9/12 28 Charaka Samhita Chikitsa 16/7-11 29 Susruta Samhita Uttara 44/3 30 Astanga Hridaya Nidana 1/3-4 31 Charaka Samhita Chikitsa 16/12 Susruta Samhita Uttara 44/5 Astanga Hridaya Nidana 13/8 Astanga Sangraha Nidana 13/9 Madhava Nidana 8/3 32 HaritaSamhita 3/8 Vangasena Panduroga /2 33 Charaka Samhita Chikitsa 16/17-30 Astanga Hridayam Nidana 13/7 Madhava Nidana 8/1 Yogaratnakara Panduroga Nidana /1 34 Susruta Samhita Uttara 44/4 35 Charaka Samhita Chikitsa 16/17-18 Astanga Hridayam Nidana 13/8-10 Susruta Samhita Uttara 44/7 36 Charaka Samhita Chikitsa 16/19-22 Astanga Hridayam Nidana 13/10-11 Susruta Samhita Uttara 44/8 37 Charaka Samhita Chikitsa 16/23-25 Astanga Hridayam Nidana 13/11-12 Susruta Samhita Uttara 44/9 38 Harita Samhita Panduroga Chikitsa 8/10 39 Charaka Samhita Chikitsa 16/27-30 Astanga Hridayam Nidana 13/13-14 40 Charaka Samhita sutra 3/3 41 Astanga Hridaya Nidana 1/8 42 Charaka Samhita Chikitsa 16/9-11 43 Ibid 16/4, 9-11 44 Susruta Samhita Sutra 21/36 45 Auartely medical review. Vol. 47 no-2 april, 1996 46 Susruta Samhita Uttara 44/13 47 Charaka Samhita Chikitsa 16/31-33 Susruta Samhita Sutra 33/23 Madhava Nidana 8/12-15

Literary review - Contemporary science 55

The most important function of the red cell is the transport of hemoglobin,

again important function of hemoglobin is to supply of essential oxygen to all cells

tissues of the body and to maintain normal colour of skin and mucous membrane.

The most common and important disorder associated with the disease of the red cell

is Anaemia, which defined as qualitative and quantitative deficiency of R.B.C count

and or hemoglobin percentage in relation of standard age and sex.

There are endless causes of Anaemia. But iron deficiency is the commonest

cause of Anaemia. It is also the commonest nutritional disorder in humans and widely

prevalent almost all over the world although more common in the developing

countries like ours.

Classification of Anaemia

Anaemia can be classified in different way but the etiological and

morphological classification is most important.

Etiological classification of Anaemia

From etiological point of view Anaemia can be classified into three sub groups

1. Anaemia due to deficient supply of nutrients or pre modular causes - these

includes deficiency of high protein diet, iron, Vitamin B12, folic acid, vit. C etc.

2. Decreased production of red cell or medullar cause - it includes leukemia,

Aplasia, chronic infection, rheumatoid arthritis etc.


3. Anaemia due to blood loss and or break down of R.B.C i.e., post medullar

causes. It includes acute blood loss, chronic blood loss, congenital or acquired

haemolysis etc.

Classification of Anaemia based on etiological factors

Premedullary Medullary Post medullary

1. Deficiency of high protein diet

Fe++ Mg++

2. Minerals Zn Cobalt

3. Vitamins • Vit B12 • Folic acid • Vit. C

1. Leukaemia 2. Multiple Myeloma 3. Metastasis 4. Apalstic Anaemia Primary (Unknown cause) 5. Chronic Infection 6. R.A.

Acute Chronic

Secondary (Known cause) drugs like Chloramphenical, Gold, Anticonvulsent, Anti Cancer repeated exposure to Radio active therapy

Haemolysis (break down of RBC) Haemorrhage (extravassation of Blood)

Intra corpuscular defect (congenital) • Thalassaemia • Sickle cell

Anaemia • spherocytosis

Extra corpuscular defect (acquired) • Misma D blood

transfusion • Snake venom (Viper) • Immunological

disorders

Acute haemorrohagic

shock

Chronic Iron deficiency

Anaemia

Corpuscular defect • G6 PD deficiency • Pk deficiency • Eleptocyposis


Morphological classification

Anaemia can be classified in terms of the appearance of the red cells. There are

three major types of Anaemia:

1. Hypochromic microcytic with a low mean corpuscular volume ( M.C.V.).

2. Normochromic normocytic with a normal ( M.C.V.).

3. Macrocytic with a high ( M.C.V.).

Summary of iron balance (in our body)

The iron balance may be summarized (In adult) as follows:

Input Body Iron Output

Male Average : 1mg/day derived from foods a) animal muscle b) Vegetables - the

average diet contains 10 to 20 mg Iron of which about 10% is absorbed.

N.B. for Female it is about 2mg.

Total 3 to 6 gms. a) functional Iron in haemoglobin myoglobin 80% at least enzyme systems transferrin b) storage Iron in Liver, Spleen, Bone marrow 20% as Ferrritin and or less Hemosedarin

Average 1mg/day Skin desquamation and miscellaneous secretion Menstruation This extra loss of about 0.5 to 1 mg requires extra input in the females

Iron deficiency Anaemia results when this delicate balance is upset in one of three

main ways, described below:

1. In creased output: this almost always occurred by blood loss - often small in

amount and chronic (1 ml blood loss = .5mg iron). In the female uterine bleeding

is a common cause and in both sexes bleeding from the alimentary tract is

important.


2. Decreased input:

A) Poor diet (including diets containing substances antagonistic to iron

absorption e.g., phytates pbhosphates).

B) malabsorcption - due to bowel disease or post surgical.

3. Increased body requirement:

a) During rapid growth in childhood.

b) In pregnancy

Usually Anaemia develops slowly (except in case of serious hemorrhage)

Iron of deficiency

Metabolisation of reserves (First hemosedarin then feratin)

Exhaustion of reserves Increased absorption of available in diet may postpone

Deficient synthesis of hemoglobin

Anaemia

Iron deficiency Anaemia

Anaemia due to deficient of iron in the body is known as iron deficiency

Anaemia. The exact prevalence of iron deficiency Anaemia is difficult to define.

Morphologically it belongs to hypochromic microcytic group.


Hypochronic microcytic Anaemia

Due to Iron deficiency Other than Iron deficiency

Sideroblastic Anaemia Thalassaemia Anaemia of chronic disorders

Causes of iron deficiency:

Iron deficiency Anaemia develops when there is an inadequate amount of iron for

hemoglobin synthesis. A normal level of hemoglobin is maintained for as long as

possible until all the iron stores are depleted; during this time latent iron deficiency is

said to be present -

Poor intake

Decreased absorption

Increased demands

Blood loss

Most iron deficiency occurs from blood loss. Pre menopausal women are

always in a state of precious iron balance owing to menstruation. Nutritional iron

deficiency is rare in developed countries. In UK, it is sometimes see in vegetarian.

Asian women eating chapatis containing phytate. The commonest cause of iron

deficiency worldwide is blood loss from gastrointestinal tract due to hook work

infestation.


The causes vary with the age and sex of the patients. Careful consideration of

the clinical features, especially of the history, will establish the causes in many cases,

but further investigation is often necessary.

Major etiological factors in iron deficiency:

1) Females in the reproductive period of life

• Menstruation

• Pregnancy

• Lactation

• Pathological blood loss

• Deficient diet

2) Adult males and post menopausal females

• Pathological blood loss

• Deficient diet

3) Infant and children

• Deficient diet

• Diminished iron stores at birth.

4) chronic gastrointestinal blood loss due to

• peptic ulcer

• haemorrhoids

• hiatus hernia

• carcinoma of the stomach

• carcinoma of the colon

• chronic aspirin ingestion

• oesophageal varics

• ulcerative colitis

• hook worm infestation


Clinico pathological changes

Changes in Anaemia

Haematological Non haematological (epithelial tissue changes)

a) blood picture -

i) R.B.C. ii) W.B.C. iii) Platelet

b) Bone marrow - c) Biochemical findings

a) Angular cheilosis and atrophic glossitis b) Dysphagia c) Gastric mucosa d) Koilonychia e) Minimal changes in peripheral nerve

A. Hematological

a. Blood picture

1. R.B.C

Changes in the blood are mainly in the red cells which become microcytic (cells

smaller-mean diameter <6.7) and hypochromic (contain less hemoglobin i.e., less

well stain).

The M.C.V. (f1) (mean cell column) is low <80

The M.C.H. (Pg) (mean cell hemoglobin) is low<25

The M.C.H.C. (mean corpuscular hemoglobin concentration is low<30%

(Normal = 34%)

The serum iron (normal 13-32 u mol/ 1) is raised>70 (2.5-4.0mg.1)

The bone marrow is hyper cellular and contains many small poorly haemoglobinised

normoblast. No stainable iron is present.


2) W.B.C

The white cell count and differential are usually normal. Macropolycytes are

often found.

3) Platelet

The platelet count is usually normal but may be slightly to moderately increase

especially in-patients with hemorrhageic or hemolytic manifestation.

b. Bone marrow

The bone marrow is hyper cellular and contains many small poorly

haemoglobinised normoblast. No stainable Iron is present. Haemosiderin store is

depleted. Macropogcytes are found a few.

c. Bio - chemical findings

the level of serum iron is decreased due to deficiency in total amount of iron present

in the body. The level of serum iron is reduced to values usually ranging from 2.5 to

10u mol/1 and the total iron binding capacity (TIBC) of the serum is increased

sometimes upto 100u mol/1

normal values ;

serum iron ; 60 - 150ug/100ml.

Serum TIBC ; 270 - 380ug/100ml

B) angular cheilosis and atrophic glossitis ;

Fissures at angles of mouth is occure and atrophy of the papillae of tongue resulting

in pale, smooth, shiny and glazed tongue.


c) dysphagia ; difficulty in swallowing due to constriction at the entrance of

oesophagus and incordinate movements in pharynx. Desquamating epithelial

cells forms.

d) Gastric mucosa ; here the gastric mucosa become thin. Gradually

hypochlorhydria and achlorthydria occurs. This aggravates any malabsorption

of iron.

e) Koilomychia ; dystrophy of the finger nails in which they are thinned and

concve, with raised edges occurs. This also known as brittle spoon-shaped

nails.

f) Minimal changes in periferal nerves ; causing paraesthesia. Here thing ling in

hands feet occur.

PATHOGENESIS

Anaemia develops usually when the supply of iron is insufficient for the

requirements of haemoglobin synthesis when iron balance becomes nagative,

the deficit is made good by iron mobilized from tissue stores and an adequate

supply of iron for haemoglobin formation is maintained. It is only when the tissue

stores are exhausted that the supply of iron to the marrow for haemoglobin

synthesis becomes inadequate and hypochronic anaemia develops

Thus iron deficiency may be regarded as developing as two stages ;

a) the progressive depletion and ultimate exhaustion of available tissue iron

stores and

b) the development of anaemia.


This increased demand occurs in children during the peiod of growth and in

women during their reproductive period of life.

During the period of growth, there is a progressive increase in the number of red

cells in the body and consequently in the total amount of haemoglobin. This

results in an increased demand for iron by the marrow for haemoglobin synthesis.

There is an additional, but much smaller demand for the synthesis of mioglobin in

the progressively increasing mass of other tissues. Growth is most rapid from the

age of 6-24 months, the time of the greatest incidence of iron deficiency Anaemia

in young children.

During the reproductive life of the memale, menstruation, pregnancy, parturition,

and lactation significantly increased the physiological requirements for iron. The

average monthly loss from menstruation is 15-28mg. Each pregnancy requires

about 500-600mg. For the fetus and to cover food loss parturition, although this is

partly compensated for by the absence of menstrual loss. Lactation causes

further demands even though the iron content of breast milk is relatively low.

Pathological blood loss.

Since 60-70% of the total iron content of the body is contained in the

haemoglobin of red cells, it is obvious that the loss of blood to any extent uses

lowering of the total body iron. The normal adult has tissue ironreserves sufficient

to replace between one-third and one-half of the circulating haemoglobin (see

table 3.1). once this reserve is exhausted, continued bleeding causes a state of

iron deficiency . blood loss from pathological lesions may cause iron deficiency

anaemia at all ages and in both sexes, but the development of iron deficiency


must be viewed specially seriously in adult males and in females after the

menpause in whom there is no physiological cause for the deficiency.

Inadequate intake.

Inadequate intake may result from either nutritional deficiency or impaired

absorption. In western countries inadequate intake is generally a contributing

rather than a sole causative factor, except in the presence of increased

physiological demand or haemorrhage.

Nutritional deficiency as a result of an inadequate diet is of major importance in

infants and young children. It may also occur in adults due to poor economic

circumstances, dietary fads or dislikes, and anorexia, specially in pregnancy.

Poor bioavailabilty of dietary non-haem iron is an important factor is an imprtant

factor in the third world.

Literary review - Chikitsa 66

When we examine the patient suffering from Panduroga it is to be analyzed that

the Pandu rogi will be curable or not? Because Acharya Charaka and Susruta has

described the treatment of sadhya Panduroga only48. The line of treatment in sadhya

Panduroga is as follows.

Chikitsa sutra

Initially Panduroga has to be unctuated with ghrita and when samyaksnigdhata is

attained the dosha have to be evacuated either with vamana or virechana according to

the necessity. When patient attains suddhakostata selected shamana aushadhi has to

be administered.

In general Pandu patient after having the unctuouation virechana is administered

as the Pandu is a pittaja vyadhi. For the virechana triphala ghrita with lodhra kalka or

any other virechana aushadhi with ghrita can be given49.

Acharyas has prescribed very specifically sneha prayoga in vataja Pandu to take

out roushyata of Vata, tiktarasa in pittaja Pandu as it creates saitya in the body and katu

rooksha ushna dravyas in kaphaja Pandu to rule out the effect of Kapha. Dwandwaja

and sannipataja pandu are treated with combinations and permutations according to the

necessity50.


Snehana

In Panduroga there is natural reduction in snehabhava of the body along with

raktalpata, alpamedaskata, nissara, ojaksheya etc., roukshatwa is appeared on whole

body therefore there is great necessity of snehana. Acharyas has prescribed the

snehana as abhyantara snehana as well as bahya snehana In Panduroga. The snehas

used for the treatment of Panduroga are given below51.

Panchagovya gritha

Mahatikta gritha

Kalyanaka gritha

Panchatikta gritha

Triphala gritha

Due to samyak snehana vatanulomana takes place Agni comes to its normal stage

snigdha varchaskata snigdhata and mardhavata is also found out52.

SHODHANA

Acharya Charaka has described the urdhwa as well as adhoshodhana in the

treatment of Panduroga. The shodhana to be assessed in those patients of Panduroga

in which vyadhibala, rogibala, degree of srotorodha in mridhbakshnajanya Panduroga

are in much severe form.

VAMANA

According to Dalhana mridu vamana can be given in the Panduroga with respect

to ritu, desha, kala, rogibala etc., where as charaka advised teekshna vamana.

Vamanartha dravya :

Kathakaphala or dhamargava,

ikishwaku kalpa,

kritevadana kalpa.


VEERACHANA

Virechana is the best shodhana karma of Pitta dosha. In Panduroga Pitta dosha

place a great role in Samprapti. Hence Virechana is the best and most acceptable

shodhanakarma in Panduroga.

Virechana prayoga :

Mridukosto rogi -

1. Godugdha or gomutrayukta dugdha up to 15 days. (Vagbhata)

2. Dantikwatha + gambari phala or draksha phala

3. Pittaja pandu - nishothara churna + dwiguna sharkara

4. Kaphaja pandu - aragwadha majja + trikatu churna

5. Vataja pandu - gomootra + haritaki churna

Panduhara grithas :

Charaka Samhita

• Dadimadi gritha,

• Katukadi gritha,

• Pathy gritha,

• Dantigritha,

• Drakshadi gritha

Susruta Samhita

• Haridra gritha,

• Darvyadi gritha,

• Bruhatyadi gritha

Vagbhata:

• Durlabhadi gritha


Dosha vishesha Chikitsa in tabular form53

1. Vataja pandu - snehabhuvistha

2. Kaphaja pandu - katu, tikta and ushna dravya

3. Pittaja pandu - tikta and sheetal proyoga

4. Sannipatika pandu - vimishrayoga proyoga

5. Mridbhakshanajanya pandu - mrittika bhakshana niverana , doshaja chikitsa

Other formulas:

• Novoyasa loha,

• Poonarnava mondura,

• Pandu panchanana,

• Mondura vataka,

• Monduradyaristha,

• Dhatrayarista,

• Lohasava,

• Tapyadi loha,

• Dhatrayavaleha

Bhasma :

• Loha bhasma,

• Swarnamakshika,

• Mondura, tamra

Importance of (Loha) iron in the treatment of Pandu:

Astanga Sangraha and Astanga Hridaya mentions importance of iron. Vagbhata

said that iron is superior drug for treatment of Pandu. Charaka, Susruta, Vagbhata,

Sarangadhara, Bhavamishra etc., all ancient authors mentioned many drug formulae

which contains iron or iron compounds for the cure of Pandu54.

Literary review - Chikitsa

Pathyapathya55 Pathya Ahara

Sukadhanya varga - purana shali, purana yava, godhuma

Shamidhanya varga - mudga mashara

Mamsa varga - jangala mamsa -matsya

Saka varga - patola vruddha, kushmanda, jivantika, vartaka,

Lashunadwayam, bimbi, punarnava and nagakesara

Phala varga - toruna, kadaliphala, abhaya, dhatri

Ikshu varga - ikshu rasa

Gorasa varga - takra, ghritha, navaneetha

Mutra varga - surabhi jala

Madhya varga - souviraka, tushodaka

anya dravya - guduchi, dronapuspi, haridra, chandana,

yavakshara and lohabasma

Apathya Ahara Rasa - kshara, amla, katu, lavana

Anna - virudha bhojana, asatmya bhojana

Jala - adhikambupana, dushitajala

Krtanna varga - pinyaka

Shamidhanya varga - masha, tila, kulatha, nishpava

Sneha varga - tila taila

Gorasa varga - dahi masthu

Madhya varga - sukto souviraka

Ahara dravyas - hingu, tambula, teekshnapadartha like,

krishna Maricha, vidhahipadratha, atiushnapadratha,

mrittbhakshana.

Literary review - Chikitsa

48 Susruta Samhita Uttara 44/14 Charaka Samhita Chikitsa 16/39 49 Yogaratnakara Panduroga Nidana 27 50 Ibid 26 - 28 Charaka Samhita Chikitsa 16/116 51 Charaka Samhita Chikitsa 16/43 Astanga Sangraha Chikitsa 12/ Astanga Hridaya Chikitsa 16/ 52 53 Charaka Samhita Chikitsa 16/116 54 Astanga Hridaya Uttara 4/41 55 Charaka Samhita Chikitsa 16/41-42 Susruta Samhita Uttara 44/ Harita Samhita Panduroga Chikitsa 8/34-36

Materials and Methods - Drug review 71

1. Guda

Sanskrit Guda

Hindi Gud

English Tracle, Jaggary

Kannada Bella

Synonyms Guda, Ikshusara, Madhura, Rasapakaja, Sishupriya,

Sitadi56,

Utpatti well-cooked sugarcane juice when solidifies and

becomes hard like stone is known as guda57.

Properties

Rasa madhura

Guna Laghu (purana Guda)

Doshaghnata Tridosha shamaka


Uses58

Purana guda is said to be best because of its action over all dhatu vaha

samstana. It is agni vardhaka and ruchya, there by easily digests it self and

nourishes and kindles the Jatharagni. It is vrishya and also claimed as sadya

shukrala, in association with shukravardhaka dravya forms of sugarcane or

especially purana guda is prescribed. Its role on rakta and rakta vaha srotas

is remarkable. It enriches the production and shows the qualitative and

quantitative increase of the Rakta dhatu. It is also Hridya as its action

conferred on Rasa and Rakta reflects as such rasarakta complex is flown in

the hridaya and dashadhamani. It is said as mala mootra vikara shodhaka

and acts on prameha (Kaphaja) as it is mootrala. Very specifically it cures a

condition of rakta kshaya lakshana and Vyadhi such as Pandu. It is

shramaharam also. Dark brown Jaggary (purana Guda) has far more Iron59.

Amaika prayoga

Guda as anupana together with Nagara, Haritakai and Ardhraka taken, it

mitigates Vata, Pitta and Kapha respectively.


2. Nagara

Zingiber officinale60, roscoe.

Sanskrit : Shunti

Hindi : Sonth

Kannada : Shunti

English : Dry zinger

Family : Scitaminaceae

Synonyms :Sunti, Nagara, Mahowshadha, Viswabheshaja,

Sringavera,

Distribution:

Ginger is cultivated in many parts of India; on a large scale in the warm, moist

regions, in Madras, Cochin and Travanacore, and to a somewhat less extent in

Bengal and the Punjab.

Description:

Rhizome, stout, tuberous with erects leafy stems 0.6 to 1.2-meter height.

Leaves narrow, flowers greenish. It is a well-known plant.


Parts used:

Scraped and dried rhizomes

Preparation of Shunti (dried ginger):

The green is first sun- dried, cleaned and soaked in water. The outer skin is

scraped off and the scraped ginger washed and again sun-dried. Both ginger and

shunti are used as condiment and also medicinally.

Pharmacological properties:

Rasa katu

Guna laghu

Veerya ushna

Vipaka madhura

Prabhava Kaphavata shamaka

Constituents:

“Indian ginger contains an aromatic volatile oil,1 to 5 p.c. of light yellow colour

having a characteristic odour and containing camphene, phellandrene, zingiberine,

cineol and borneol; gingerol a yellow pungent body an oleo-resin-“gingerin” the active

principle, other resin and starch; K-oxalate. The essential oil and resin, to which

ginger owes its pungent flavor, occur just beneath the skin or epidermis. The pungent

principles of ginger are not found in the volatile oil. It has how ever, been isolated and

been named gingerol, but its true chemical nature has not yet been finally settled.”


Action:

It is aromatic, carminative, stimulant to the gastrointestinal tract, and

stomachic, also sialogogue and digestive. Externally, a local stimulant and

rubrifacient.

Action and uses in Ayurveda - katu rasam, ushna veerya, vata-kapha-hara,

katu vipaka, lagu, snigda, pancha, ruchya, vrishya, swarya, vibhandha hara. In

grahani, agnimanthya, amavatha, chardhi, swasa, shoola, arsas, anaha, hrith-roga,

udhara roga, externally in Kapha, swellings, head ache.

Uses in general:

Ginger is prepared from the dried rhizomes. Ginger being aromatic and

pleasantly pungent, is commonly used as a spice and in the preparation of

condiments, curries, ginger bread, and a conserve and syrup and made from the

fresh younger rhizomes. Rhizomes are also pickled.


3. Mandura

Sanskrit - manduram, rakta bhasma

English - iron rust, inpure oxide of iron, magnatite ironoxide, magnatite

Hindi - lohaka zung

Kannada - kabbinada kilubu or kitta

Chemical name - Ferroso - Ferric oxide

Synonyms61 - lohakitta, lohabhava, lohamala, lohetchista, loha singhanika,

kitti, sinhanam,

Panduroga is well known disease since vedic period. In Rigveda and

Atharveda Panduroga is mentioned by word viloha. The meaning of this word is loss

or deficiency of loha. There are mainly two types of treatment while treating the

Panduroga.

Lohayukta yoga

Lohaitara vanaspathika yoga

Mandoora is a upadahtu of lohadhatu of course all Ayurvedic grantha karas have

advise the use of mandura that is lohakitta in the treatment of Pandu.

Utpatti62

When loha is heated for long time its malabhaga get separated from it. Which

is known as lohakitta or mandura. On biting the hot loha it losses its mala which is

known as mandura.


Sources

Mandura is occurred free in soil. The red colour soil is due to that upadhatu of

loha that is mondura in India southindia main sources of mondura.

Properties63

Rasa - kashaya, tikta, madhura

Veerya - sheeta

Other gunas - guru, ruksha,sara, sheeta

Karmukata - action on doshas, vatanashaka, kapha pittanasaka

that is tridoshagna

Action on dhatus raktavridhikara, vrishya

Action on organs chakstushya pleehagna

Others lekhan vayastapana, deepana, rucheekara

Rogaghnata -Pandu, arsha, shotha, pleeharoga, kamala, kumba

kamala, halimaka, shosha, medoroga, prameha, krimi,

kustha.

Amenorrhoea, dysmenorhoea, menorrhagia, chlorosis also diarrhoea, chronic

bowel complaints, dyspepsia, and nervous disease,(neuralgia) kidney disease,

(albuminuria) guda mandura is a favorite medicine for dyspepsia with pain after

taking food.


4. Tila

Sesamum indicum linn

All Ayurvedic authorities advocated the use of sneha dravyas (fats or lipids)

both for dietary purposes64 and for the purpose of treatment as medicated oil and or

the pure fats both internally or externally in sneha kriyas65. Of these sneha drayas

four are important one of vegetable origin viz tila (seeds of Sesamum indicum linn)

and the other three being of animal origin viz. Ghrita, vasa and majja. The

understanding that in Ayurveda, Tila is the most efficacious for the purpose of

strength and oleation may recognize the importance of the tila66.

Nomenclature

Sanskrit -tila,

English - gingelly, sesamum

Kannada - yellu

Hindi - til

Family - pedaliaceae

Synonyms - phala, snehaphala, hemadhanya,

pavitra, pitrutarpana, papaghani, jatila


Description

This plant is cultivated extensively throughout India. Erect herbs, about 70 cm

high; branching often from base, puberculous, leaves up to 10 x6 cm lanceoate,

lower pedatisect, glabrous above, puberulous beneath. Flowers pinkish purple about

2.5 cm long, axilliary, solitary or in recemes about 4 cm long pedicles glandular at

base, calyx 0.3 long 5 partite, puberulous, corolla 2.5 cm long ventrioles faintly

gibbous at base 2-lipped, stames4, didagnamous, include ovary glabous style

filiform, stigma 2 lobed, disk annular, capsules 1.5 cm long quadrangular, shortly

beaked pubscent dehiscing about half way down, seeds black compressed glabrous

oily. Flowering and fruit in April - July.

The seeds and oil are used in Ayurvedic medicines. Bhavamishra states that

according to the color, the tila seeds are of three-varieties - out of the black variety

are used and considered the best.

(1) black

(2) white and

(3) Red.

Properties of sesame seeds67

Rasa - katu, slight kashaya, more of madhura and tikta

Virya - ushna

Vipaka - katu, according to sushruta - madhura68

Gunas - snigdha, guru, swada, (tasty) cold to touch


Composition of Tila

Saturated fatty acids -

Palmitic acid - 9.1%

Stearic acid - 4.3 %

Arachidic acid - 0.8 %

Unsaturated fatty acids

Oleic acid 45.4 %

Linoleic acid - 40.4%

Karma69

- vataghna, grahi, balya, good for hair, skin, teeth and ulcers, improves

Agni and intellect, increases semen, reduces the urinary out-put. It does

not aggravate Kapha, Susruta states that it alleviates Kapha, deepana,

pachana, brimhanam, balyam, preenanam, vrishyam lekhanam, promotes

skin health, intellect digestive fire, health of eyes,complexion, strength and

stability of mamsadhatu, krimighna, causes constipation and reduces the

quantity of urine, good for the hair, cleanses the garbhashya and yoni

helps in overcoming aging process and fatigue, causes Rakta Pitta.

- In combination with different drugs, it is said to be cured all diseases, and

when it is used as roborant to emaciate and reduces the obese. It is used

for alleviation of Vata, in vasti, nasya for internal administration, to be

used in ears and eyes and in dietary articles.


5. Pippali

Piper longum. linn.

Sanskrit Pippali

Hindi Peepal

Kannada Hippali

Family Piperaceae.

Synonyms Magadhi, Kana, Krishna,Chapal, Ushana, Kola70.

Distribution

Hotter provinces of India, Ceylon, Malasia etc it is cultivated.

Parts used

Dry fruits.

Short description- Fruits are very small, ovoid in shape and completely sunk in solid

fleshy spike which is 2.5 to 3.8 cm. It is ovoid– oblong, erect, blunt and blackish

green in colour.

Pharmacological properties71 –

Guna -Laghu, snigdha, Teekshna.

Rasa - Katu

Vipaka - Madhura.

Veerya - Anushna Sheeta.

Doshaghnata - Kapha vata hara.


Chemical composition –

Resin, volatile oil, Starch, gum, fatty oil, inorganic matter and an alkaloid,

piperine.

Actions72 –

It subsides Kapha and Vata because of its katu rasa and snigdha guna

respectively. It acts as yogavahi. According to Rajanighantu it is Jwara nashaka,

veerya vardhaka and jatharagni deepaka. Bhavaprakasha clearly states that, if

Pippali added to Guda it subside Ajeerna, aruchi, kasa, swasa, kusta, Pandu and

krimiroga.


Preparation of the drug " Gudanagaradivati 73"

Ingredients of Gudanagaradivati is as beneath -

Guda - 1 part

Nagara - 1 part

Mandura - 1 part

Tila - 1 part

Pippali - 2 parts

Collection of drugs

Medically useful parts or the ingredients of Gudanagaradivati were collected

from the local market of the Gadag and the Mandura bhasma of reputed company

was purchased from the Ayurvedic medical shop.

Method of preparation

The collected drugs Nagara, tila, and Pippali were powdered with help of

Powder making mechine. Then Mandura Bhasma was added to the prepared Churna

and mixed thoroughly. Then 1 part of Guda and 4 parts of water boiled together

made it into semisolid paste then pre prepared Churna added to this preparation and

made into 500 mg. Vati and dried and collected.

Storage

The dried and collected vati are stored in glass jar. Its shelf life period is

enhanced for 1 year as it is made in the form of vati with Guda as binding agent.


56 Rajanighantu Paniyadi varga 100 57 Bhavaprakasha poorvakhanda Ikshuvarga 23 58 Ibid 24-25 Rajanighantu Paniyadi varga 100 Yogaratnakara poorvardha 59 API text Book of Medicine pp859 60 Indian materia medica pp 1308 - 1315 Indian medicinal plants Vol IV pp 2435 -2438 Bhvaprakasha Haritakyadi varga Dravyaguna Vijnana pp263 Susruta Samhita Sutra 46/ 61 Rasatarangini 20/124 62 Bhavarakasha poorvakhanda Dhatwadi varga 52 Rasatarangini 20/123 63 Ibid 132 Bhavarakasha poorvakhanda Dhatwadi varga 49 Indian materia medica Vol II pp62-63 64 Charaka Samhita Vimana 1/13 Ibid Sutra 27/286 65 Ibid 13/9 66 Ibid 13/12 Susruta Samhita Sutra 45/130 67 Charaka Samhita Sutra 27/30 Astanga Hridaya Sutra 6/21 Bhavaprakasha poorvakhanda Dhanyavarga 63-65 68 Susruta Samhita Sutra 46/39 69 Bhavaprakasha poorvakhanda Dhanyavarga 63-65 70 Bhavaprakasha poorvakhanda Haritakyadivarga 54 71 Ibid 55 72 Ibid 57-58 Rajanighantu Pippalyadi varga 13 Charaka Samhita Vimana 1/16 73 Ibid Chikitsa 16/72 Astanga Hridaya Chikitsa 16/25

Material and Methods - Examination 84

Present day unwholesome food habits are influencing deficiencies of vital

nutrients (iron, Vitamin B12 etc.) as the main cause of Pandu. The Bhootabhishanga

(parasitic infection) also has a prime role in developing Pandu. Even after so many

treatments are available from alternative systems. The incidence of Pandu is high in

the developing countries due to malnutrition and poor hygienic status.

Ayurveda advocated treatment of Pandu with many herbal and herbomineral

combinations. Out of such one claimed by Charaka Samhita, as an effective recipe

for Pandu is "Gudanagaradi Vati".

The Pandu Roga is dealt in Brihatrayee with its treatment elaborately. The

whitish discoloration of skin is said as Pandu Varna the disease named as

Panduroga, which shows its lakshanas in between twak (skin) and Mamsa (muscle).

The compound of present study (Gudanagaradi Vati) is mentioned in Charaka

Samhita said to be effective in Pandu Roga. The composition of Gudanagaradi Vati

(guda, sunthi, mandoora, tila and pippali) also individually has considerable effect

over Raktadhatu and Raktavaha Srotas.

Objectives of study

To study the efficacy of Gudanagaradi Vati in Pandu


Methods of study

Source of data

1. Patients

Patients suffering from Pandu are selected from post graduation and research

center O.P.D of D.G.M Ayurvedic Medical College Hospital by preset inclusion and

exclusion criteria.

2. Drug

Trial drug (Gudanagaradi Vati) is prepared in college pharmacy after proper

identification of the raw drugs.

3. Literature

Literary aspect of study is done from classical Ayurvedic texts, modern texts

and updated through journals, which is already explained from Drug review.

Method of collection of data

Exclusive criteria

• The patients below mentioned are excluded

• Age group of below 5 years and above 55 years

• Associated with vital organic disease

• Sever blood loss

• Parasitic infection

• Discontinuation of treatment schedule

Inclusive criteria

The patients of both sexes between the age of 5 to 55 years with mild to

moderate Anaemia, other than that of exclusive criteria are included in the present

study.


Study design

Prospective clinical trail

Sample size

Minimum of 25 patients are subjected for the study

Treatment schedule of Gudanagaradi Vati

Posology

• 40mg/kg, body weight /24 hours or

• At the maximum of 2gm./24hrs. in divided doses.

Study duration

• 21 days

Assessment of results

• The results will be assessed by clinical, as well as

hematological study.

• Hb% is assessed for all at the interval of 7 days.

Hematological Investigations

• Hemoglobin percentage

• Total count of R.B.C

• Packed cell volume

• Mean corpuscular volume

• Mean corpuscular hemoglobin concentration

• Peripheral smear

• Serum iron


Examination of a patient with Pandu (Iron deficiency Anaemia)

I. History

i) Female in reproductive period of life

Menstrual history - especially menorrhagia

Pregnancy - number of frequency

Miscarriage

Diet

Alimentary blood loss

Haematuria, epistaxis, haemorrhoids

Gastro intestinal surgery

Chronic Asprin ingestion

ii) Male and post menopausal females

Alimentary blood loss

Hemorrhoids

Haematemesis or melaena, epistaxis, haematuric haemoptysis

Gastro-intestinal surgery

Diet

Chronic aspirin ingestion

iii) infant and children

Detail dietary history, especially and supplemental feeding

Premature, multiple births or iron deficiency mother

Gastrointestinal disturbance

Blood loss


II) physical examination

Abdomen-abdominal mass, tenderness, feature of liver disease

Rectal examination

Pelvic examination

Telangiectasia of face and mouth - tongue, mucous membrane, palpable

conjunctiva, palm etc.

Nails

III) laboratory investigation

Urine - routine and microscopic examination

Stool - occult blood and any parasites (especially hook worm and

roundworm).

Blood - R.B.C. morphology

Routine test of blood i.e., T.C.,D.C., Hb%. E.S.R.

Total R.B.C. count P.C.V., M.C.V., M.C.H.,M.C.H.C.

Serum iron

Serum transferrin (total iron binding capacity)

Serum ferritin

Bone marrow - iron staining

After confirm action the iron deficiency Anaemia investigate to know -

Inadequate intake

Malnutrition

Mal absorption


The sample case sheet for the evaluation of Pandu patient is as under. In this

demographic data is thoroughly dealt as par the guidelines of research. Then chief

complaints with duration are dealt with specific focus on the Vaivarnya, Shrama,

Bhrama, Gatra shoola, Pindikodwestana, Sadana, Alpameda, and Shotha.

Associated complaints with the duration are also classified.

A general examination is undertaken as a routine for the evaluation of fitness

of patient. Specific Ahara and Vihara Nidana according to the classical texts

summarized. The lakshana were drawn special importance with reference to the

Pandu in general and in specific with that of classification of Pandu, such as Vataja

Pittaja, Kaphaja and Mritbhashana janya pandu. Dwandwaja and sannipataja are

specified as the combination and permutations of doshic involvement.

Asadhya lakshana are noted to rule out the problematic area of research.

Parameters of objective determined are monitored at regular intervals and entered in

to the special case sheet for "Evaluation of the effect of Gudanagaradi Vati in

Pandu".

Method of Estimation of Objective parameters,

1. Hb% 2. RBC counts 3. PCV 4. MCH 5. MCHC 6. Serum Iron

Is as follows.


1. Hemoglobin estimation

Sahli's method (sahli's haemoglobinometer ; superior - germany)

This is based on conversion of hemoglobin to acid haematin, which has a

brown colour. Fill hemoglobin tube till 20 mark with N/10 HCL. To this add blood

sucked till the specific mark (20µl) on the hemoglobin pippette and wait for 5-45

minutes. During this time keep stirring the mixture of acid-blood in the tube. Add

distilled water until a match is obtained with the brown glass standard (comparator)

provided. Read the lower level of fluid mensicus on gm/% side of the tube. Report

hemoglobin in gm/100 ml of blood. If hemoglobin is less than 2 gm%, take double the

quantity of blood and divide the result by 2. If haemoglobin concentration is extremely

high dilute blood with equal amount of normal saline, take the reading and multiply by

2. This mehod, however, does not estimate carboxyhaemoglobin, methaemoglobin

and sulphaemoglobin. Non-hemoglobin substances (protein, lipids) in plasma and

cell stroma may influence the colour of blood diluted with acid. It therefore is not a

very satisfactory method.

Gradations of Heamoglobin percentage:

Mild Hb% above 9.0 gm/100 ml

Moderate Hb% between 9.0 to 6.0 gm/ 100 ml

Severe Hb% below 6.0 gm


2. RBC' count

Diluting fluid:

This should be isotonic so that RBC's are not haemolysed. Normal saline can

be used but it may cause crenation of the RBC's and allow rouleaux formation.

One can use

1. Sodium citrate 3 gm.

Formalin 1 ml

Distilled water to 100 ml (Cheap and good)

Or

2. Hayem's fluid

Mercuric chloride 0.5 gm

Sodium chloride 1.0 gm

Sodium sulphate 5.0gm

Distilled water to 200ml.

(Needs to be made frequently and in hyperglobulinaemia one may set precipitation of

protein so RBC clumping may occur. Mercuric chloride acts as an antiseptic).

Method

Draw blood to the 0.5 mark in the RBC pipette. Wipe tip clean and draw

diluting fluid to the 101 mark. Shake for 3 minutes. Charge the chamber. Count the

RBC's using 40 X objective in the 80 smallest squares as indicated in the diagram of

the chamber.


RBC count =

No of cells counted x dilution factor x depth factor

Area counted

Where dilution id 1 in 200, depth is 1/10 mm

80 = 1 Area counted is sq mm

400 = 5

Number Counted x 200 x10 =

1/5

= number counted x 10000

Interpretation

RBC counts are low in Anaemia (Pandu) and high in polycythemia causes of

Anaemia has already been discussed.

3. Haematocrit /packed cell volume (PCV)

Definition

Haematocrit is the volume of red cells expressed as a percentage of the

volume of whole blood in the sample. The venous Haematocrit is almost same as

that obtained from a skin puncture. Dried heparin, EDTA or double oxalates are

satisfactory anticoagulants.


Methods

Wintrobe's tube

Fill the wintrobe's tube till the 100 mark on top with a pasteur pipette ensuring

that there are no air-bubbles in the flood column. Centrifuge this tube for 15 minutes

at 3500 rpm (or longer at lower speeds) until packing is complete. After centrifuging,

the blood is separated into 3 layers, a column of red blood cells at the bottom, a

narrow middle layer - buffy coat of white blood cells, and platelets and the topmost

fluid column of plasma. The percentage of the height of the column of blood occupied

by packed red cells constitutes the Haematocrit. Roughly the Haematocrit value is

three times the hemoglobin concentration.

Sources of error

1. Inadequate mixing of blood

2. Irregularity of the bore of the tube

3. Incomplete packing

Normal range

Men - range 42-52% average =47%

Women - range 37-47% average = 42%

4. MCH (The mean cell hemoglobin)

Hemoglobin in grams / liter = Pg.

Red cell count / ml Normal MCH in adults is from 27 to 32 pg.


5. MCHC (The mean cell hemoglobin concentration )

Hb in grams X 100 = 31 to 35 gm%

PCV 6. Serum Iron (Nitro -PAPS method)

Principle

Iron ions are dissociated from is carrier protein, transferring in an acid

medium and simultaneously reduced to the ferrous form. The ferrous ions react with

the chromogen Nitro-PAPS to a colour-complex highly specific. The resulting

absorbance is directly proportional to the iron contents.

Transferrin-bound iron is released at an acid pH and reduced from ferric to

ferrous ions. These ions react with ferrozine to form a violet colored complex, which

is measured spectrophotometrically at 560 nm. The absorbance measured at this

wavelength is proportional to serum iron concentration.

Total Iron-binding capacity (TIBC)

A known amount of ferrous ions are added to serum at an alkaline pH. The

ferrous ions bind with transferrin at unsaturated Iron-binding sites. The additional

unbound ferrous ions are measured using the ferrozine reaction. The difference

between the amount of ferrous ions added and the unbound ion measured is the

unsaturated iron-binding capacity (UIBC). The TIBC is equal to the serum iron

concentration plus the UIBC.

Clinical significance

In most cases, both serum iron and TIBC values are necessary for greatest

diagnostic significance. Low serum iron values are seen in chronic blood loss,


insufficient intake or absorption of iron, and increased demand on the body stores

(e.g. pregnancy). Elevated serum iron values are seen in increased red cell

destruction, decreased red cell synthesis, increased iron intake, or increased iron

stores release.

Increase in the TIBC may be due to increased production of apotransferrin

(e.g. chronic iron deficiency) or an increased release of ferritin, as in hepatocellular

necrosis.

Decreases in the TIBC can occur with cirrhosis and hemachromatosis due to

a deficiency in ferritin, or in nephrosis due to a loss of apotransferrin.

Kit contents

Iron reagent - ready-to-use

Iron standard 30µmol/1 - ready-to-use

Avoid contamination of ready-to-use reagents. Always use fresh pipette tips.

Keep always the caps tightly closed. Reagents are stable until expiry date mentioned

on the label. Store all the reagents at 2-8°C.

Warning and precautions

1. For in vitro diagnostic use

2. Avoid ingestion of reagent, as toxicity has not yet been determined.

3. Specimens should be considered infectious and handled appropriately.

4. Do not interchange the caps of reagent bottles.


Specimen collection and storage

1. Fresh, unhemolyzed serum is the specimen of choice.

2. Serum should be separated as soon as clot has formed.

3. Heparinized plasma may be used but other anticoagulants should not

be used to avoid possible iron contamination.

4. Serum iron is reported to be stable for four days at room temperature

(15-30°c) and seven days at 2-8°C.

Determination of iron

Wavelength : 578 nm Pipette into test tubes Blank Standard Test Iron reagent 500µl 500µl 500µl Distilled water 25µl - - Standard - 25µl - Sample - - 25µl Mix and incubate at 37°C for 3 min. and measure the absorbance of sample A(s) and

standard A (STD) against the blank A (BL), at 578nm.

Calculation of Serum iron (µmol/1) =

A(s) - A (BL) X 30

A (STD) - A (BL) Expected values

Men 9.5 - 30µmol/1(53-167µg/dl)

Women 8.8-27 µmol/1(49-151µg/dl)

Linearity 180µmol/1

Special case sheet follows in the next page.

observations 101

Chart number 1- Demographic Data of “Evaluation of the effect of Gudanagaradi Vati in Pandu”.

S .no OPD Age Sex Occupation Economical Status Food Result

M F S A L 1 2 3 4 5 V Mx C P R NR D 1 417 16 + + + + + 2 248 55 + + + + + 3 397 50 + + + + + 4 499 15 + + + + + 5 624 35 + + + + + 6 707 29 + + + + + 7 729 22 + + + + + 8 730 26 + + + + + 9 747 42 + + + + + 10 683 55 + + + + + 11 750 25 + + + + + 12 710 25 + + + + + 13 872 40 + + + + + 14 751 45 + + + + + 15 875 45 + + + + + 16 963 55 + + + + + 17 998 35 + + + + + 18 921 38 + + + + + 19 1045 25 + + + + + 20 340 21 + + + + + 21 995 30 + + + + + 22 903 40 + + + + + 23 906 32 + + + + + 24 1062 40 + + + + + 25 831 40 + + + + + Total 10 15 0 18 7 9 8 6 2 0 13 12 07 13 05 00 00

M= male, F= female, S= Sedentary, A= Active, L= Labor, 1= Poor, 2= Lower Middle class, 3= Middle class, 4= higher middle class, 5 = Aristocrat, V= Vegetarian, Mx = Mixed diet.

C = Cured (well responded), P = Palliative, R = Responded, NR =Not Responded, D = Discontinued

observations 102

Chart number 2A-1- Chief Complaints of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”.

S.no

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A

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

1= Pandu nakha, 2= Pandu netra 3= Pandu twacha 4= Pandu vit 5 = Pandu mootra, 6 = Pandu sira 7= Krishna nakha, 8= Krishna netra 9= Krishna twacha 10= Krishna vit 11 = Krishna mootra, 12 = Krishna sira

13= Aruna nakha, 14= Aruna netra 15= Aruna twacha

observations 103

Chart number 2A-2 - Chief Complaints of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”.

S.no

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A

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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

16= Aruna vit 17 = Aruna mootra, 18 = Aruna sira 19= Peeta nakha, 20= Peeta netra 21= Peeta twacha 22= Peeta vit 23 = Peeta mootra, 24 = Peeta sira 25= Shukla nakha, 26= Shukla netra 27= Shukla twacha

28= Shukla vit 29 = Shukla mootra, 30 = Shukla sira

observations 104

Chart number 2B - Chief Complaints of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”.

S.no 1 2 3 4 5 6 7 8 9 10 11 12 13

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

1 = akshikoota shotha, 2= gandapradesha shotha, 3= kapola shotha, 4= bhru shotha, 5= lingashotha, 6= nabhi shotha,

7=pada shotha, 8= shrama, 9= bhrama, 10= gatra shoola, 11= pindikodwestana, 12= sadana, 13= alpameda

observations 105

Chart number 3 - Associated Complaints of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”.

S.no

1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

18

19

20

21

22

23

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 + + + + + + + + +

1= Aruchi, 2= Agnimandya, 3= Toda, 4= Praseka, 5=Alasya, 6= Tandra, 7= Karna kshweda, 8= Sishira dweshi,

9=Swedavabhava, 10= Mritbhashanapekshana, 11= Jwara, 12=Swasa, 13= Kasa, 14= Trishna,15= Swarakshaya,

16= Sheerna Loma, 17= Hritdrava, 18= Anaha, 19=Chardi, 20=Klama, 21= Kampana, 22= Prabhanasha, 23= Nissara

observations 106

Chart number 4 - Nidana (etiology) of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”.

S.no

Ahara Vihara A1

A2

A3

A4

A5

A6

A7 V1

V2

V3 V4 V5 V6 V7 V8

A B C a b c d e f g h i j k l m

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 + + + + + + + +

A1=Amla, A2=Lavana, A3=Teekshna, A4=Kshara, A5=Viruddha, A6=Asatmya, A7=Mrit, A=Kashaya, B=Kshara, C=Madhura, V1=Ativyayama,

V2=Ativyavaya, V3=Manasika, a=Chinta, b=Shoka, c =Bhaya, V4= Vyasana, d= Madyapana, e=Dhoomapana, V5=Nidra, f= Sound, g= Disturbed, V6=

Malapravritti, h=Regular, i= irregular, V7= Mootra Pravritti, j=Prakrita, k= Vaikrita, V8= Rajah Pravritti, l=Prakrita, m=Raktapradara or Atyartava

observations 107

Chart number 5a - Vatajadi lakshana of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”

s.no Vataja Pandu Pittaja Pandu 1 2 3 4 5 6 7 8 9 10 A B C D E F G H

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 + + + + + +

1= krishna or aruna varna or rookshata of nakha, netra, twacha, vit mootra, sira,2= soochivat vedana. 3= bhrama, 4= kampana,

5= parswashoola, 6= shirashoola, 7= shopha, 8= asya vairasya, 9= anaha, 10= bala kshaya, A= peetata of twacha, nakha vit, netra mootra, B= daha, C= trisna, D= sheeta kamitwa,

E= sweda pravritti, F= jwara, G= atisara, H= dourbalya,

observations 108

Chart number 5b - Vatajadi lakshana of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”

s.no

Kaphaja Pandu Mitbhashanajanya Pandu

1 2 3 4 5 6 7 8 9 10 11 12 13 14 A B C 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 + + + + +

1= shwetha vrna of twacha, mootra, mala netra mukh, 2= shota, 3=tandra, 4=aslasya, 5= shareera gurutva,

6= kapha praseka, 7= chardi, 8= bharama, 9= klama, 10= swasa, 11= kasa, 12= aruchi, 13= vak graha, 14= swara graha, A= shotha of akshikoota, bhroo, gandapradesha, nabhi, linga pada, B= krimikosta, C= rakta kapha mala pravratti,

observations 109

Chart number 6 - Assessment of " “Evaluation of the effect of Gudanagaradi Vati in Pandu”

S.No Hemoglobin Percentage (gm%) Total RBC count(millions/cu.mm) Packed cell volume

Serum Iron (mmol)

B 7 14 21 D B 7 14 21 D B A D B A D 1 8.8 9.2 10.2 10.6 1.8 4.6 5.0 5.1 5.2 0.6 43 45 2 6.5 12.5 6.0 2 8.8 9.2 9.4 9.6 0.8 4.8 5.6 5.8 5.8 1.0 44 46 2 6.4 13.0 6.6 3 8.4 8.8 8.8 8.6 0.2 4.4 4.4 4.6 4.6 0.2 35 37 2 6.8 11.0 4.2 4 6.8 7.0 7.6 8.2 1.4 4.6 4.7 4.8 5.0 0.4 43 45 2 7.0 10.6 3.6 5 9.0 9.2 9.4 10.0 1.0 5.2 5.2 5.3 5.4 0.2 40 44 4 8.1 24.8 16.7 6 10.0 10.2 10.6 11.0 1.0 4.8 5.0 5.1 5.3 0.5 35 37 2 13.5 20.8 7.3 7 9.4 9.8 10.2 10.8 1.4 4.8 5.0 5.1 5.4 0.6 38 42 4 8.0 16.0 8.0 8 7.6 8.4 9.8 10.8 3.2 4.9 5.2 5.4 5.8 0.9 40 42 2 17.6 26.0 8.4 9 9.0 10.0 10.6 11.2 2.2 5.0 5.1 5.2 5.6 0.6 44 46 2 26.2 32.0 5.8

10 6.2 7.4 7.6 8.2 2.0 4.6 4.8 4.8 5.0 0.4 44 48 4 9.86 14.0 4.14 11 6.8 7.2 8.4 9.4 2.6 4.7 5.0 5.2 5.4 0.7 40 44 4 7.4 14.6 7.2 12 9.8 10.2 10.6 11.0 1.2 4.9 5.0 5.2 5.4 0.5 49 50 1 6.1 11.0 4.9 13 9.4 10.2 10.6 11.0 1.6 5.2 5.4 5.6 5.8 0.6 42 45 3 7.2 14.0 6.8 14 7.0 7.6 7.8 10.0 3.0 5.0 5.1 5.4 5.8 0.8 40 42 2 5.8 31.0 25.2 15 6.8 7.2 8.2 9.0 2.2 4.8 5.0 5.1 5.4 0.6 40 44 4 28.5 32.0 3.5 16 8.0 8.4 9.0 9.8 1.8 4.7 4.8 5.0 5.2 0.5 41 43 2 26.0 34.0 8.0 17 8.0 8.6 8.8 9.4 1.4 4.9 5.0 5.2 5.4 0.5 40 42 2 16.0 22.0 6.0 18 9.2 9.8 10.2 10.8 1.6 5.0 5.3 5.6 5.8 0.8 40 42 2 7.4 16.0 8.6 19 8.0 8.4 9.0 9.8 1.8 4.8 5.0 5.2 5.4 0.6 39 42 3 8.0 14.0 6.0 20 8.6 9.4 10.2 11.0 2.4 5.0 5.2 5.4 5.8 0.8 42 45 3 5.0 10.0 5.0 21 7.6 8.2 9.0 9.4 1.8 4.4 4.5 4.6 5.0 0.6 40 44 4 5.4 11.0 5.6 22 9.8 9.8 9.9 10.0 0.2 5.1 5.4 5.6 5.8 0.7 39 42 3 5.8 12.6 6.8 23 6.2 7.0 7.8 9.0 2.8 4.6 4.8 5.1 5.4 0.8 40 44 4 6.0 14.0 8.0 24 9.8 10.5 10.8 11.6 1.8 4.8 5.0 5.2 5.6 0.8 42 44 2 7.2 12.0 4.8 25 9.2 9.8 10.0 10.8 1.6 4.8 4.8 5.0 5.2 0.4 42 45 3 7.0 14.6 7.6

B= Before A= After D= Difference 7+ 7days interval, 14= 14 days interval 21 = 21 days interval

observations 110

Chart number 7 Statistical assessment for the “Evaluation of the effect of Gudanagaradi Vati in Pandu”

S.No Category Mean

Deviation Standard Deviation

Standard Error

"t" Test P - Value Remarks

1 Hemoglobin %

1.712 0.7618 0.1524 11.234 <0.001 Highly Significant

2 Total RBC count


3 Packed Cell Volume


4 Serum Iron


Standardization and statistical representation of Gudanagaradi Vati expressed above

shows Highly Significant in its studies with P value < 0.001 in all aspects.

The correlation co-efficient between hemoglobin and total RBC counts before treatment (experiment)

is 0.4589 and after the completion of trail drug is 0.586. This shows that there is an increased relation between the above-mentioned investigations, Hb% and Total RBC count.

We tested for the significance of correlation co-efficient "t" value is 3.47 and "P" value is less then 0.01 (<0.001), which is a highly significant.

The correlation co-efficient between Hemoglobin % and Serum Iron before to treatment is

negatively co-related (r = -0.044), where as after treatment it was positively correlated (r = 0.067). It shows that inter relationship between two investigations mentioned above moderately improved.

Discussion and Conclusion 111

The study of 25 cases of Panduroga was treated with gudanagaradivati in

post graduation and research center (Kayachikitsa) of Sri DGM Ayurvedic medical

college Gadag.

Nidana described in the classics taken into account by the detailed

questioning patient’s pin pointedly to understand specific Nidana of Panduroga.

Among the 25 patients reserved for the trail most of the patients having the habit of

eating Amla, Lavana, rasapradana Ahara dravyas. Some patients were fond of taking

atiushna Ahara as their food. Some patients were fond of taking tikshnaaharas like

chilies etc., in their food. Many patients are of labor group and they are with

ativyayama and chinta, bhaya, etc., in the trial group.

Majority of the signs and symptoms explained in our classics regarding

Panduroga were observed in this clinical study. The patients who were selected for

clinical trail had panduta (discoloration) of twacha, nakha, netra, In all most all the

cases with maximum of chief complaints and associated complaints.

In relation to Agni patients having mandagni are largely prone for the

development of disease Panduroga.

The Anaemia, which results from the deficiency of iron and characterized by

reduction of Heamoglobin concentration, red cell count and packed cell volume to

below normal level is called as iron deficiency Anaemia (I.D.A). In this study, all these

signs and symptoms and lab investigations shows that all most all the patients

suffering from the Pandu can be considered as iron deficiency Anaemia (I.D.A) in


contemporary medicine. The importance to the Loha i.e. Iron (IDA) is even given by

Acharyas of Ayurveda and also at present study. The role of Iron in the formation of

Rakta is not elaborated in Ayurveda, through suggesting it as main line of treatment

to Pandu, Vagbhata and Charaka justified its importance in respect with rectification

of pathogeneses. Therefore in this study very precisely concentrated on iron

deficiency Anaemia in contemporary review of literature.

In the Ayurvedic view of classification, present study Panduroga has

Sannipathaja Panduroga more. In those vatakaphaja Panduroga’s are more. Even

though Pandu is said as Pittapradanavyadhi, here in the study 6 patients did not

shows any Pittaja lakshnas and more over they show purely vatakaphaja lakshanas.

Other 19 patients fall under sannipatajapandu i.e., Tridosha (dementedly kaphaja)

lakshanas.

In this study the treatment of Panduroga by Gudanagaradi vati was selected

from Charaka Samhita Pandu Chikitsa and also Vagbhata referred in his work

Astanga Hridaya. The ingredients are Guda, Nagara, Mandura, Tila, and Pippali.

In the drug review the actions of Guda is being dealt that Guda is

Agnivardhaka, Raktavruddhikara, Vrishya, Hridya, and Tridoshagna are to be

considered here. In this preparation Guda acts as binding agent and also definitely

notified that it is chiefly Pandurogahara i.e. reduces Pandu.

The ingredient Nagara as the synonym indicates it is Viswabheshajam i.e.

medicine for all ailments. Here the action of Nagara Vatakaphahara vrisha, Swarya,

Ruchya are to consider. It also acts in Hridroga, Agnimandya, Swasa, and Shoola.

Mandura is updhatu of lohadhatu and also having the same qualities as

lohadhatu has. Iron is present in Heamoglobin, Myoglobin, Cytocroms and many


Oxidetive enzymes. Heamoglobin percentage contains ferrous iron it is essential for

carrying to different tissues. Mandura otherwise said as Iron in the form of Ferric

Oxide. All Ayurvedic classics dealt the use of Mandura in the treatment of

Panduroga. Its action raktavridhikara helps in Panduroga which is the one of the

main compliant i.e., raktalpata. Also its actions are informed that panduhara,

shotahara, pleeharogahara, shoshahara, and krimihara, which are the upadravas or

nidanardakara vyadhies of Panduroga.

Even though it is said that the Tilasevana is leads to Panduroga, It is one of

the ingredients at present treatment schedule. It is supposed that the Pandu, which is

a chronic disease developed because of Loha content decrease in the body by

means of disturbing the assimilation or absorption of Loha is because of the excess

intake of tila or its byproducts. At this background using Tila in the combination

suggests that the leena dosha by using a material causing the disease in stipulated

doses along with the ingredients, those rectifies the disease will improve the

deficiencies of Loha in the body. It constructs Normal Rakta to perform its normal

function “Jeevana” by getting more Heam to exchange O2 and CO2 in the body. It

helps in promoting skin health and acts as deepana, pachana, brimhana, preenana,

balya and Krimighna.

Pippali is one of the ingredient i.e., 2 parts. Pippali which is yogavahi it

enhances the action of other ingredients. It subsides Kapha because of Katu Rasa it

subsides Vata because of Snigdha guna. Pippali added with Guda subsides Ajeerna,

Aruchi, Kasa, Swasha which Panduroga having the lakshanas. It’s effect over

Panduroga and Krimiroga are to be considered here.


36 to 4532%

26 to 3524%

16 to 2524%

6 to 154%

46 to 5516%

Age incidence

Present study of “Evaluation of the effect of Gudanagaradi Vati in

Pandu" has the following age incidences. It suggests that much of the patient's

fall under the age groups in between 16 to 45 i.e. 80%, rest of 20% is from other

groups. The data as follows. As 80% of people incidence shows between the age

groups it suggests that nutritional deficiencies are more along with essential

elements for the synthesis of Rakta in these group. In further care taken towards

filling the gap of deficiencies and rectification of Rakta formation can correct the

Pandu.

S.No Age group Number of patients percentage 1 6 to 15 1 4 2 16 to 25 6 24 3 26 to 35 6 24 4 36 to 45 8 32 5 46 to 55 4 16

Total 25 100

Graph number - 1

Age incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"


Sex incidence

“Evaluation of the effect of Gudanagaradi Vati in Pandu" has the

following data in sex incidence. From the data available we can draw a conclusion,

that the incidence of Pandu is more in female's i.e. 60% (15 Patients), as such nature

is allowing more loss of blood in the form of menstruation and where as male's are of

only 40% (10 Patients). The ratio reveals in the study is as 2:3 for male and female

respectively.

S.No Sex Number of patients Percentage

1 Male 10 40 2 Female 15 60 Total 25 100

Female60%

Male40%

Graph number - 2 Sex incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"


0

18

7

0 5 10 15 20

Labor 7

Active 18

Sedentary 0

Occupation incidence

Study suggests that the patients out of active occupational group are more

prone to get the Pandu. Out of 25 cases studied 18 are in active and 7 are in labor

group of occupational categories. The percentages of active and labor are 72 and 28

respectively. It clearly suggests that the patients those who are active in their nature

of work needs more calories of energy which can not supplement the needs of

sequential progression of Rakta formation, in further the active occupational require

more O2 exchange, which is based on the Haem in the blood. Study clearly

evidential that Gudanagaradi vati is more helpful in these catagories.

S.No Category Number of patients Percentage

1 Sedentary 00 00 2 Active 18 72 3 Labor 07 28 Total 25 100

Graph number - 3

Occupational incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"


98

6

2

00

2

4

6

8

10

Economical Status 9 8 6 2 0

Poor Lower middle class Middle class Higher middle

class Aristocrat

Economical status

Data collected in the study shows that, more values of percentage i.e. 68%

(17 patients) of the patient's fall under economically lower group or other wise at the

poverty line. Few of the middle and above class patients are also reported that is 8

patients out of 25 refers to 32%, suggests that there is remarkable malnutrition,

deficiency of Iron and Pandu even in this group, where essential commodities are

plenty available in day to day life. For the rectification of the above said the

"Gudanagaradi Vati" is a medicine fits to the all groups of patients with exceptionally

at low price.

S.No Category Number of patients Percentage 1 Poor 9 36 2 Lower middle class 8 32 3 Middle class 6 24 4 Higher middle class 2 8 5 Aristocrat 0 0 Total 25 100

Graph number - 4

Economical status incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"


Vegetarian52%

Mixed diet48%

Diet (Food Habits) The food habit distribution in the locality of research has more percentage of

vegetarians in comparison even though the are said as mixed diet dependents. The

ratio of percentage between vegetarian and mixed diet is 13:12 i.e. 52% and 48%

respectively. In Pandu there is no specific vegetables mentioned in Ayurveda to

supplement the deficiency of Iron, which gives rise the disease. The data values are

given in data table along with graphical representation.

S.No Category Number of patients Percentage 1 Vegetarian 13 52 2 Mixed diet 12 48 Total 25 100

Graph number - 5 Diet incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"


0

2

4

6

8

10

12

Before treatment 8.328 4.816After 7 days 8.86 5.012After 14 days 9.38 5.184After treatment 10.044 5.42Difference of Beforeand After

1.712 0.604

Heamoglobin % (gm/L) Total RBC count in million/ Cumm

Objective parameters at mean values in regular intervals

Objective parameters are said to be foremost for assessing any research

works. Present study Pandu applies Heamoglobin %, Total RBC count, PCV and

Serum Iron as prescribed parameters. The study reveals that the effect of

Gudanagaradi Vati has consistent convinced results over Pandu. The data referred

to the statistics explained in detail at the master charts. Here the mean values are

taken for the evaluation and presentation. The data follows in the tabular form.

Before treatment

After 7 days

After 14 days

After treatment

Difference of Before and After

Heamoglobin % (gm/L)

8.328 8.86 9.38 10.044 1.712

Total RBC count in million/ Cu mm

4.816 5.012 5.184 5.42 0.604

Graph number – 6 Objective parameters at mean values in regular intervals

Heamoglobin and RBC count


05

1015202530354045

Before 40.88 10.3504After 43.6 17.74Difference 2.72 7.3896

PCV % Serum Iron

The PCV % and Serum Iron values before and after the treatment is as

follows in tabular form and graphical.

Before treatment After treatment Difference of Before and After

PCV % 40.88 43.6 2.72 Serum Iron (mmol) 10.3504 17.74 7.3896

Graph number – 7 Objective parameters at mean values in regular intervals

PCV and Serum Iron


Palliative52%

Cured28%

Responded20%

Not Responded

0%

Discontinued0%

Result

The present study “The evaluation of effect of Gudanagaradi Vati in

Pandu” is based on assessment criteria’s as clinical symptomatology and

Heamoglobin percentage. Clinically all the patients are observed to attain

normalcy and free from Panduroga. Hematologically even though they did

not reach the normal stipulated values of Heamoglobin they show remarkable

increase of serum Iron along with risen values of Heamoglobin percentage,

up to 3.2 % as highest difference in the study. The mean value difference oif

base line data is 1.712. The result declared is as under.

Category Number of patients Percentage

Cured 07 28

Palliative 13 52

Responded 05 20

Not Responded 00 00

Discontinued 00 00

Graph number 8 Result of the “Evaluation of the effect of Gudanagaradi Vati in Pandu"


The result declared above is based on the Heamoglobin percentage along

with clinical assessments. Clinical assessment of all patients falls under cured, as

they show symptomatically well being. The Heamoglobin as objective parameter

considered in the present study was categorized in to three for the convenience of

study. Usually 10% of the normal value deviation is considered to state either

pathological state or recovery. All most all the patients have got rise of 10% of

Heamoglobin to their baseline data. The categories of assessment of Heamoglobin

are as under.

2 to 4 % rise in Heamoglobin % fall under Cured (well responded)

1 to 2 % rise in Heamoglobin % fall under Palliative (better responded)

0 to 1 % rise in Heamoglobin % fall under Responded

Other wise Not Responded and

Discontinued.

With the above criteria result is cured or well responded is 7 patients i.e. 28%,

palliative or better responded is 13 patients i.e. 52% and

Responded is of 5 patients’ i.e. 20%.

No discontinued or not responded cases recorded.

Future prospective

Though in this work maximum efforts put to fulfil the subject and to achieve

the aims and objectives of the present project work. There is still a wide scope to a

greater distance of studies as following.

Grouping could be made and in one group the efficacy of the drug on the other

hand studied after subjecting the individual for Samshodhana karma.

As the disease has wide range of etiology one can assess the role of

Gudanagaradivati in each of the etiological factors with its individual components

and also as a whole.

123

Summary

This study was formulated to evaluate the effect of Gudanagaradivati in

Panduroga.

The definition, history, etiology, Nidana panchaka, classification of Pandu,

upadrava, sadhya asadhyata and the treatment of Pandu according to the

classics and also the definition and etiological classification of anemia and iron

deficiency anemia were reviewed in the study.

The drug Gudanagaradivati and its composition was reviewed and discussed and

importance of Gudanagaradivati in the treatment of Pandu with respect to its

etiology is highlighted.

The study was conducted in a prospective clinical trial design on 25 patients.

Gudanagaradivati was administered in a dosage of 500 mg. 4 times a day or 2

gms/ 24 Hrs which ever is higher after the food for 21 days.

In this study the incidences of age, sex, occupation, economical status and diet

incidents were highlighted in the observation.

Each and every symptom of Pandu reported in this study showed response to the

drug.

No side effect of Mandura (iron) was reported during the treatment period.

The drug significantly elevated the Heamoglobin concentration in blood. It is

proved through statistical statements as p value <0.001, which is highly

significant.

Over all response to the drug was exceptionally best.

124

References for


1 Astanga Hridaya Sutra 1/3 2 Susruta Sutra 1/6 3 Rigveda 10-50-11 4 Atharvaveda 4-9-3 & 1-22-2 5 Charaka Samhita Sutra 18/43 6 Charaka Samhita Chikitsa 16/6 7 Susruta Samhita Sutra 14/ 8 Charaka Samhita Chikitsa 15/17 9 Astanga Hridaya Sutra 11/4 10 Astanga Hridaya Shareera 3/8 11 Susruta Samhita Shareera 4/3;

Charaka SamhitaShareera 7/5 12 Charaka Samhita Chikitsa 15/27 13 Charaka Samhita Sutra 24/3

Susruta Samhita Sutra 5/6 14 Charaka Samhita Sutra 24/23 15 Charaka Samhita Sutra 24/21 16 Susruta Samhita Sutra 14/9 17 Astanga Hridaya Sutra 11/17 18 Charaka Samhita Vimana 5/9 19 Charaka Samhita Vimana 8/114 20 Charaka Samhita Chikitsa 16/7-8 21 Susruta Samhita Uttara 44/3 22 Susruta Samhita Nidana 11/17 23 Susruta Samhita Shareera 2/21 24 Charaka Samhita Chikitsa 2/27

25 Susruta Samhita Shareera 6/27 26 Harita Samhita 3-9-39 27 Susruta Samhita Shareera 9/12 28 Charaka Samhita Chikitsa 16/7-11 29 Susruta Samhita Uttara 44/3 30 Astanga Hridaya Nidana 1/3-4 31 Charaka Samhita Chikitsa 16/12

Susruta Samhita Uttara 44/5

Astanga Hridaya Nidana 13/8

Astanga Sangraha Nidana 13/9

Madhava Nidana 8/3 32 HaritaSamhita 3/8

Vangasena Panduroga /2 33 Charaka Samhita Chikitsa 16/17-30

Astanga Hridayam Nidana 13/7

Madhava Nidana 8/1

Yogaratnakara Panduroga Nidana /1 34 Susruta Samhita Uttara 44/4 35 Charaka Samhita Chikitsa 16/17-18

Astanga Hridayam Nidana 13/8-10

Susruta Samhita Uttara 44/7 36 Charaka Samhita Chikitsa 16/19-22


Susruta Samhita Uttara 44/8 37 Charaka Samhita Chikitsa 16/23-25


Susruta Samhita Uttara 44/9 38 Harita Samhita Panduroga Chikitsa 8/10 39 Charaka Samhita Chikitsa 16/27-30

Astanga Hridayam Nidana 13/13-14 40 Charaka Samhita sutra 3/3 41 Astanga Hridaya Nidana 1/8

42 Charaka Samhita Chikitsa 16/9-11 43 Ibid 16/4, 9-11 44 Susruta Samhita Sutra 21/36 45 Auartely medical review. Vol. 47 no-2 april, 1996 46 Susruta Samhita Uttara 44/13 47 Charaka Samhita Chikitsa 16/31-33

Susruta Samhita Sutra 33/23

Madhava Nidana 8/12-15 48 Susruta Samhita Uttara 44/14

Charaka Samhita Chikitsa 16/39 49 Yogaratnakara Panduroga Nidana 27 50 Ibid 26 - 28

Charaka Samhita Chikitsa 16/116 51 Charaka Samhita Chikitsa 16/43

Astanga Sangraha Chikitsa 12/

Astanga Hridaya Chikitsa 16/ 52 Charaka Samhita Sutra 22/8 53 Charaka Samhita Chikitsa 16/116 54 Astanga Hridaya Uttara 4/41 55 Charaka Samhita Chikitsa 16/41-42

Susruta Samhita Uttara 44/

Harita Samhita Panduroga Chikitsa 8/34-36 56 Rajanighantu Paniyadi varga 100 57 Bhavaprakasha poorvakhanda Ikshuvarga 23 58 Ibid 24-25

Rajanighantu Paniyadi varga 100

Yogaratnakara poorvardha 59 API text Book of Medicine pp859

60 Indian materia medica pp 1308 - 1315

Indian medicinal plants Vol IV pp 2435 -2438

Bhvaprakasha Haritakyadi varga

Dravyaguna Vijnana pp263

Susruta Samhita Sutra 46/ 61 Rasatarangini 20/124 62 Bhavarakasha poorvakhanda Dhatwadi varga 52

Rasatarangini 20/123 63 Ibid 132

Bhavarakasha poorvakhanda Dhatwadi varga 49

Indian materia medica Vol II pp62-63 64 Charaka Samhita Vimana 1/13

Ibid Sutra 27/286 65 Ibid 13/9 66 Ibid 13/12

Susruta Samhita Sutra 45/130 67 Charaka Samhita Sutra 27/30

Astanga Hridaya Sutra 6/21

Bhavaprakasha poorvakhanda Dhanyavarga 63-65 68 Susruta Samhita Sutra 46/39 69 Bhavaprakasha poorvakhanda Dhanyavarga 63-65 70 Bhavaprakasha poorvakhanda Haritakyadivarga 54 71 Ibid 55 72 Ibid 57-58

Rajanighantu Pippalyadi varga 13

Charaka Samhita Vimana 1/16 73 Ibid Chikitsa 16/72

Astanga Hridaya Chikitsa 16/25

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Co-Guidance : Dr. K. Siva Rama PrasadGuidance : Dr.Ch.Ranga Rao

“ The evaluation of the effect of

Gudanagaradi Vatiin Pandu

By

I.B.Kotturshetti

Introduction • In clinical practice first observation falls on

patients skin.

• The “Panduvarna” i.e Anemic Skin colour is easily noted by the physician.

• Thus the cause of the Pandu is noted as deficiency of vital nutrients and minerals.

• The incidence is so high in developing countries even though multi discipline regimens are available.

In Ayurvedic classics the term "Pandu" (Anaemia) familiar as a-

DiseaseSign or symptomComplication

Definition:• The word derives from

to it

•The pale white or yellowish white colour -Students Sanskrit English dictionaryby Vaman Sivaram Apte

Nidana:Samhita Ahara Vihara Manasika

KsharaAmla

Rasa

Lavana

DiwaswpnaVyayamaAtivyavaya

Kama

Guna Atiushna Prati Karma ChintaNishpav BhayaMasha Krodha

Tila taila

Charaka

Dravya

Prinyaka

Ritu vaishamyaVegadharana

Shoka

Amla DiwaswpnaRasa:

Lavana Ativyayama

Guna AtiteekshnaMadhya

SusrutaMadhava NidanaYogaratnakara

DravyaMrit

Pandu Poorvarupa Hrit Spandhana (palpitation) Rooksha (dryness) Swedabhava (No sweating) Shrama (Fatigue) Twak Sputana (cracking of skin) Hrillasa (Nausea) Pada gourava (Heaviness in lower limbs) Mridbhakshaneccha Akshi Koota shota (puffiness around eyes) Avipaka (Indigestion) Peeta mutrata (yellow urine) Peeta Purisha (yellow stool) Aruchi (loss of appetite)

SampraptiPitta pradhan tridosha prakopak nidan sevan

Agni vikar and rasa dusti

Dosha prakopa (mainly Sadhakapitta inside heart)

Prasara via srotas by vayu

Dhatu dusti (vikriti)

Dhatu kshaya (raktalpata)

Panduta (discoloration of skin)

Tabular form of Pandu Lakshana

S.No Lakshana Charaka Susruta Vagbhata1 Karnakseweda + - +2 Hatanala + - +3 Dourbalya + - +4 Sadana + - -5 Annadwesha + - +6 Shrama + - +7 Bhrama + - +8 Gatrashoola + - -9 Jwara + - +10 Swasha + - -

Tabular form of Pandu Lakshana-2

S.No Lakshana Charaka Susruta Vagbhata11 Gourava + - +12 Aruchi + - +13 Gatramardata + - +14 Gatrapeeda + - -15 Gatronmatana + - -16 Soonakshikoota + - +17 Harita varna + - Panduvarna18 Sheerna lomata + - +19 Hata prabha + - -20 Kopanata + - +

Tabular form of Pandu Lakshana - 3

S.No Lakshana Charaka Susruta Vagbhata21 Shishira dweshi + - +22 Nidraluta + - -23 Pindikodweshtana + - -24 Katiruk + - -25 Pada ruk + - -26 Pada sada + - -27 Ururuk + - -28 Kati sada + - -29 Uru sada + - -30 Dhatu saithilya + - +

Tabular form of Pandu Lakshana - 4

S.No Lakshana Charaka Susruta Vagbhata31 Ojo guna kshaya + - +32 Alpa raktata + Raktadusti +33 Alpamedaskata + - +34 Nissarata + - +35 Hridrava + - +36 Sithilendriyata + - +37 Twacha panduta + + +38 Swetakshitwa - - -39 Sweta nakhatwa - - -40 Swetha vakrata - - -

Method of collection of dataExclusive criteria• Age group of below 5 and above 55 years• Associated with vital organic disease• Sever blood loss• Parasitic infection• Discontinuation of treatment scheduleInclusive criteria

The patients of both sexesBetween the age of 5 to 55 years With mild to moderate Anaemia, Other than that of exclusive criteria

Study designProspective clinical trail

Sample size25 patients

Study duration 21 days

Posology40mg/kg, body weight /24 hours or maximum of 2gm./24hrs.

Assessment of results• The results will be assessed by clinical, as well

as haematological study.• Hb% is assessed for all at the interval of 7 days.

Hematological Investigations

Hemoglobin percentageTotal count of R.B.CPacked cell volumeMean corpuscular volumeMean corpuscular haemoglobin concentration Peripheral smearSerum iron

Preparation of Gudanagaradi Vati

IngredientsGuda - 1 partNagara - 1 partMandura - 1 partTila - 1 partPippali - 2 parts

Dravya Rasa Guna Veerya Vipaka OnDosha

Karma

Guda Madhura Laghu Seeta Madhura VPKAgni Vriddhi

RuchyaPanduhara

Shramahara

Nagara Katu Laghu Ushna Madhura KV

VatanulomanaAgni Deepana

PachanaSwarya

SwasaharaShoolahara

ManduraTikta

KashayaMadhura

GuruRooksha Seeta - VPK

Pandu, Arsha,Shootha,

Pleeharoga,Kamala, Sosha,

Krimihara

TilaKatu

KashayaMadhura

Tikta

SnigdhaGuru Ushna

Katu(Madhura

-Su)V

BalyaDeepanaPachanaBrimhanaPreenana

Twakprasadana

Pippali KatuLaghu

SnigdhaTeekshna

Anushnashee

taMadhura KV

YogavahiJatharagnideepana

KasaswasaharaPanduharaKrimiharaRasayana

Observations in StudyTotal Patients 25

• Aruchi 24

• Agnimandya 24

• Toda 20

• Alasya 24

• Tandra 20

• Kampana 18

• Prabhanasha 16

• Nissara 14

• Pandu Twacha 21

• Pandu Netra 24

• Pandu Nakha 24

• Shrama 25

• Bhrama 23

• Gatra Shoola 24

• Sadana 15

• Alpameda 19

Ahara• Amla 20

• Lavana 18

• Teekshna 17

Vihara• Ativyayama 16

• Ativyavaya 10

Manasika Karana• Chinta 23

• Shoka 14

NidanaTotal Patients = 25

Observations at the IntervalsBefore

treatmentAfter 7days

After 14days

Aftertreatment

Differenceof Beforeand After

Heamoglobin %(gm/L)

8.328 8.86 9.38 10.044 1.712

Total RBC count inmillion/ Cu mm

4.816 5.012 5.184 5.42 0.604

Statistical assessmentCategory Hb % Total RBC

countPCV % Serum

IronMean Deviation 1.712 0.604 2.72 7.3896

Standard Deviation 0.7618 0.1989 0.9363 4.515S.E 0.1524 0.0397 0.1873 0.903

"t" Test 11.234 15.1835 14.522 8.1833P - Value <0.001 <0.001 <0.001 <0.001Remarks H.S H.S H.S H.S

H.S = Highly Significant

Statistical representation of Gudanagaradi Vatishows Highly Significance with P value < 0.001.

The Correlation co-efficient between hemoglobin and total RBC counts before treatment (experiment) is 0.4589 and after the completion of drug is 0.586.

This shows that there is an increased relation between the above-mentioned investigations, Hb% and Total RBC count.

It is tested for the significance of correlationco-efficient "t" value is 3.47 & "P" value is <0.001,(less then 0.01) which is highly significant.

The correlation co-efficient between Hemoglobin % and Serum Iron before to treatment is negatively co-related (r = - 0.044), where as after treatment it was positively correlated (r = 0.067).

It shows that inter relationship between two investigations mentioned above are moderately improved.

ResultNot

Responded0%

Responded20%

Cured28%

Palliative52%

13 Patients

7 Patients5 Patients

ConclusionThis study was formulated to evaluate the effect of Gudanagaradi Vati in Pandu.In this study most of the symptoms explained in the text are reported.All symptoms reported responded well.The drug significantly evaluated the Haemoglobin concentrations in the blood.It is proved through statistical evaluation and also significance of correlation co-efficient "t" value.

Over all response to the drug was exceptionally best.

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pandu kc008 gdg

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