Introduction

January 2012

Pandu Vyadhi Visheshank

Vishay Pravesh The description of Pandu Vyadhi found Synonyms of Pandu -in Bruhat-Trayee and Laghu-Trayee is Sushrutacharya has descr ibed almost similar. But different opinions following synonyms for Pandu Vyadhi are seen about its Dooshya-Sangraha in Uttar Tantra, Adhyay 44. and classification. These are discussed Kamala, Panaki, Panduroga, under respective headings. Kumbhahvaya, Lagharaka /

Laghavaka, Alasaka / AlasakhyaThe loss of normal colour of body or Commentary on Sushrut Samhita by discolouration of skin is known as Dalhan – Though the disease caused 'Panduta' (Pallor) in practice. Along with t h e d i s c o l o u r a t i o n , l o s s o r abnormalities are seen in the texture and lustre of skin. The reflection or glow of skin colour is the main function of Bhrajak Pitta in normal state. Also, Twacha (skin) is said to be the Vyakti Sthan (site) of the Rasa and Rakta Dhatu. Colour of skin indicates the quality of Rasa Dhatu (Rasa-Sarata) and its lustre as well as texture indicate quality of Rakta Dhatu (Rakta-Sarata). due to vitiation of Pitta or Rakta is a

single entity, it is still classified in So, the discolouration of skin is caused various types according to the as a result of vitiation of the Bhrajak predominent Dosha along with its signs Pitta and loss or any abnormality in and symptoms. Same way, though lustre, texture and colour is due to specific conditions are found in vitiated Rasa-Rakta Dhatu. diseases like Kamala, Pandutva being common factor; they are considered as Ayurved Samhita Granthas described synonyms of Pandu. 'Pandu' as a separate disease. Also it But, as per the discussion in other has been discussed as a sign of many Samhita Granthas and commenteris, it other diseases. Panduta (Paleness of would be better to consider them as skin or pallor) is the cardinal sign of the different stages of Pandu.disease, thus named so. Twacha Charakacharya has also described covers the whole body, thus the Kamala as the stage arising in paleness of skin is observed all over the Pandurog af ter the excessive body. This is more specifically observed consumption of Pittakar Hetus. in nails, conjunctiva etc.

Now a days, a number of patients suffering from Pandu Vyadhi are seen due to modern lifestyle, improper dietary habits and routine and use of modern medicines. The disease 'Anaemia' discussed in Modern Science and its various types is the topic of discussion today. Its description is almost similar to that of Pandu described in Ayurved. Pallor or Paleness is the main sign of Anaemia. Anaemia is nothing but the set of symptoms arised due to reduction in the Haemoglobin count as well as quality and its Oxygen carrying capacity. Nutritional deficiency, diseased condition, excessive bleeding, medicines etc. can cause disturbance or imbalance at any level in the formation and destruction of RBCs, resulting in such a condition. The etiopathology of various types of disease resembles Pandu Samprapti, thus it will also be discussed in this 'Pandu Vyadhi Visheshank'.

yurved, as everyone knows, is not only a pathy related to treatment of

d i s e a s e s , b u t i s a Complete Science, which plays a major role in maintaining health of i nd i v i dua l s . Due t o i m p r o p e r l i f e s t y l e including faulty diet & exercise regimes, which are very common now-a-

days, number of diseases are seen, with which the patients approach Ayurvedic physicians. Among all the diseases, one disease that is the most common is Pandu Vyadhi - most commonly equated with Anaemia. It was once said that, Pandu Vyadhi or Anaemia is seen only in females, but now-a-days Pandu or Anaemia can be seen in any person - may it be males, females, children or elderly persons. The causes of Pandu Vyadhi or Anaemia may differ in every individual, but paleness or Pallor of skin (Twak Panduta) is seen in all the patients, which is a classical sign of this disease. In India many people are suffering from a disease about which they are least aware i.e. Pandu Vyadhi or Anaemia. In common day to day language it is described as 'Rakta Ki Kami' (Deficiency in quantity of Blood). Patients suffering from Pandu Vyadhi are usually unaware of the fact that, this disease can lead to some very serious complications.In Ayurved, Pandu Vyadhi has been discussed in detail. The etiopathology of Pandu Roga found in Charak Samhita, Sushrut Samhita, Ashtang Sangraha as well as Ashtang Hruday, Bhavaprakash etc. clearly indicates that, Pandu Roga can occur due to various causes and it is important to treat it in time & appropriately.According to your suggestions, we are presenting herein each & every aspect related to Pandu Vyadhi, as mentioned in the Ayurvedic texts along with its practical approach to the treatment of Pandu. We hope you will appreciate it.Anticipating your valuable suggestions regarding topics for the upcoming issues of Aarogyamandir Patrika.

Yours truly, Vd. Shailesh Nadkarni

AEditorialEditorial

Vyadhi Varnan 2Charak Samhita and Ashtanga Hruday have included when predisposed to the factors mentioned above. Pandu Vyadhi in the list of diseases caused due to vitiation (DeeÙegJe&Ce&yeueb mJeemLÙeceglmeenesheÛeÙees ØeYee... ~ - Agni being of Rasavaha Srotas (Rasapradoshaj Vyadhi); whereas responsible for these factors)Sushrutacharya has called it as Raktapradoshaj Vyadhi. Same way, the causes like Iron and Intrinsic factor When we look at this Vyadhi practically, it is observed that deficiency, Mal-absorption syndrome, hook worm, mainly Rasavaha Srotas gets affected in it leading to disorders of bone marrow, haemorrhage, drug induced further vitiation of Raktavaha Srotas. So, it can be complications etc. described in modern medicine should concluded that both of the Srotas get vitiated in this Vyadhi. also be kept in mind. The diseases like Raktarsha, Pradar, The Srotodushti is being described in the Dooshya- Raktapitta etc. with excessive bleeding should be Sangraha mentioned in Pandu-Samprapti. considered as separate diseases. The anaemia

developed in such conditions should not be considered as Hetu (Causative Factors) - Pandu as it is due to blood loss (Rakta Kshaya). The Vyadhi is caused due to Doshaprakopak Hetus, Charakacharya has said in Chikitsa Sthana, Adhyay 16 mainly diet, routine etc. vitiating Pitta. All Samhita while describing Sadhya-Asadhyata of Pandu, that Granthas have same opinion about this. Also as per the Panduta or paleness caused due to Rakta-Kshaya is a Sootra, ' jesiee meJexÓefhe cevosÓiveew~ ', the factors responsible for sign and not the disease – Pandu. reducing the Agni (Agnimandyakar) should also be

Pandu – Samanya Samprapti -included in the list of Pandu-Nidan. These causative factors are classified below. Madhav Nidan has mentioned 'Vyayam' (exercise) instead of 'Vyavay' (intercourse).

Ahara - Rasa - Sour, Salty, Caustic Guna - Extra spicy, Viruddha, Asatmya,

According to the Samprapti Sootra of Charak Samhita Teekshna, Vidagdha mentioned above, the Samprapti of Pandu Vyadhi is Dravya - Alcohol, soil, Nishpav (kidney beans), presented in the flow chart. Mash (black gram), sesame oilBeing a Rasapradoshaj Vyadhi, vitiation of the very first Vihara - Excess of exercise, sex indulgence, sleeping Dhatu after Ahara Rasa and Jatharagni is an obvious in day time, curbing natural urgesevent. This results in vitiation of Rasa Dhatu, eventually Manas - Sexual desire, excessive thinking, fear, leading to vitiation of further Dhatus in serial order. anger, mental traumaConsumption of Doshaprakopak Hetus like Ahara, mainly Others - Improper treatment, seasonal changesPitta predominance; vitiates Pitta which resides in Rasa Disease - Liver – Spleen disorders, Rheumatoid and initiates the chain of events in Pandu Vyadhi. In this Arthritis, Worms etc.event, Mandagni and Rasa Dhatu Asarata should be kept The dietary causative factors mentioned in this list in mind. Though this Pitta points towards the 'Sadhak Pitta' aggrevate Ushna and Teekshna Gunas of Pitta leading to residing in Hruday as described in Samprapti, one should its Vidaha. Rest of the factors mentioned in routine are always keep in mind that rest of the types of Pitta also get capable of vitiating Pitta as well as Vayu aggravating the vitiated. This includes vitiation of Ranjak Pitta which is Samprapti of Pandu. Also, they act as aggravating factors responsible for the conversion of Rasa Dhatu into Rakta responsible for disease by reducing the Agni. Chikitsa-Dhatu, Pachak Pitta responsible for Agni Vikruti, Bhrajak Vaishamya and Rhutu-Vaishamya (Improper or wrong Pitta reflecting skin colour and Alochak Pitta responsible treatment and seasonal variations) can affect the strength for pallor in conjunctiva. of the patient, Dhatu-Sarata, Vyadhikshamatva (Immunity)

as well as variation in appetite, which can lead to Pandu

Sadhak Pitta residing in Hruday travels in whole body through ten Dhamani (blood vessels) with the stimulation of Vayu (Rasa-Rakta Vikshepan). As a result of vitiation of Rasa Dhatu, the Rasa Mala – Kapha causes Gaurav and Shaithilya in Uttarottar Dhatu. This results in Kshaya of Uttarottar Dhatu and Oja.

oes<ee: efheòeØeOeeveemleg ÙemÙe kegâhÙeefvle Oeeleg<eg ~MewefLeuÙeb lemÙe Oeeletveeb ieewjJeb ÛeeshepeeÙeles ~lelees JeCe&yeuemvesne Ùes ÛeevÙesÓhÙeespemees iegCee: ~JÙeJeeÙececueb ueJeCeeefve ceÅeb ce=ob efoJeemJehveceleerJe leer#Ceced ~ ›epeefvle #eÙecelÙeLeË oes<eot<ÙeØeot<eCeeled ~~efve<esJeceeCemÙe Øeot<Ùejòebâ oes<ee: lJeÛeb heeC[gjleeb veÙeefvle ~~ meg. G. 44meesÓuhejòeâesÓuhecesomkeâes efve:meej: efMeefLeuesefvõÙe: ~JewJeCÙeË Yepeles, lemÙe nslebg ße=Ceg meue#eCeced ~~ Ûe. efÛe.16

mecegoerCeË ÙeLee efheòeb ùoÙes meceJeefmLeleced ~JeeÙegvee yeefuevee ef#ehleb mebØeehÙe Oeceveero&Me ~ØeheVeb kesâJeueb osnb lJe*dceebmeevlejceeefßeleced ~Øeot<Ùe keâheâJeeleeme=kedâ lJe*dceebmeeefve keâjesefle leled ~~heeC[gneefjõnefjleeved JeCee&ved yengefJeOeebmlJeefÛe ~~me heeC[gjesie FlÙegòeâ: ... ~ Ûe. efÛe.16

Suvarnamakshik Bhasma?An excellent Pittashamak, Raktaprasadak,

Balya, Yogavahi Rasayan?Useful in symptoms like palpitation, tremors,

burning sensation, excessive sweating etc. by reducing Samata and Drava Guna of Pitta ?Extremely effective Bhasma in Pandu,

containing Loha and Tamra ?Also useful in Kamala, Jeerna Jwara, Amlapitta,

Shirahshool, Udar, Kushtha, Krumi, Pradar etc.Dosage and Anupan - 125 to 250 mg 2 – 3 times a day with Ghee or honey

3

This vitiated Pitta resides in Twak and Mansa giving rise to ce=efòekeâeoveMeeruemÙe kegâhÙelÙevÙelecees ceue: ~discolouration of skin. The Bhrajak Pitta localised in the keâ<eeÙee cee®leb, efheòecet<eje, ceOegje keâheâced ~~Twak gets vitiated and pale, yellowish and greenish

keâesheÙesvce=õmeeoeR§e jew#Ùeeod Yegòebâ efJe®#eÙesled ~discolouration is seen. Charakacharya has described Pandu as a result of Dhatu Kshaya specifically in Rakta hetjÙelÙeefJehekeäJewJe œeesleebefme efve®Ceefæ Ûe ~~and Meda Dhatu Kshaya. FefvõÙeeCeeb yeueb nlJee lespees JeerÙeezpemeer leLee ~efJeot<Ùe jòebâ kegâJe&efvle oes<emlJeefÛe heeC[gYeeJeced~ meg. G. 44 heeC[gjesieb keâjeslÙeeMeg yeueJeCee&efiveveeMeveced ~~ Yee.Øe. / Ùees.j. / cee.efve.

Sushrutacharya has emphasised on vitiation of Rakta In Pandurog caused due to consumption of soil, though the Dhatu. According to the commentery of Dalhan, Doshaprakop remains the same as per the taste of soil, it Raktalpata causes vitiation of Raktagata Bhrajak Pitta also causes excessive dryness of the body (Raukshya) giving rise to discolouration of the skin. and obstructs the Srotas without getting digested in the Doshadi Sangraha - body. This Srotorodh restricts the nourishment of the Dosha - Tridosha with predominence of Pitta (mainly Uttarottar Dhatus, thus giving rise to Pandu Vyadhi. Sadhak and Bhrajak Pitta) Sushrutacharya has not mentioned its separate Samprapti Dooshya - Rasa, Rakta, Mansa, Meda, Twacha, Oja, considering it as a Doshaj type. Indriya

Srotas - Rasavaha, RaktavahaModern medicine explains the Etiopathology of the Agni - Jatharagni, Rasagni, Raktagni (Ranjakagni)disease 'Anaemia' along with its different types which are Udbhava - Hruday (Rasavaha Srotas Moolasthan)discussed further. Reduction in the RBC or Hb count due to Sanchar - Sarva Deha (whole body)any reason as a result of which its capacity to carry the Vyakti - Twak, MansantarOxygen towards the constituents of body is hampered, Marga - Bahya, Shakharesulting in a condition called as 'Anaemia'. Hook worm are Nature - Chronicalso included in the list of causes of Anaemia. They enter Apart from these, Charakacharya has also described a the body through soil or due to unhygienic conditions and separate Samprapti for Mrudbhakshanjanya Pandu adhere to the intestinal wall to get nourishment. This can (caused due to consumption of soil). It has been also be corelated with Mrudbhakshanjanya Pandu and Pandu mentioned in Grantha like Bhavaprakash, Yogaratnakar &

Madhavnidan. caused as a result of Krumi.

3Pandu Samprapti

Pittaprakopak Ahara Vihar

Hetu Sevan

Pittapradhan Doshaprakop

Varna Vikruti (Discolouration)

Pandu Haridra Harita Varna

Vitiation of Bhrajak Pitta

Raktalpata, Medalpata

Dhatukshaya, Ojakshaya

Dhatushaithilya, Gaurav

Dhatvashrit DoshaHrudaystha Sadhak

Pitta Dushti

Travels in body throughten Dhamani with the help of Vayu

Twak Mansashraya

Kapha, Vata, Rakta,Twacha, Mansa, Dushti

Mrudbhakshan

Kashay

Katu

Madhur

Pittaprakop

Vataprakop

Kaphaprakop

Doshaprakop

Raukshya

Srotorodh

Dhatuposhan Abhav

Pandu

Pandu Samprapti

Poorvaroopa of Pandu- Dhatu (Vitiation of Rasa Mala - Kapha)lemÙe efue*dieb YeefJe<Ùele: ~

Shrama - Due to Rasakshayaùodmhevoveb jew#Ùeb mJesoeYeeJe: ßecemleLee ~~ Ûe. efÛe. 16 Bhrama - Vitiation of Ushna, Teekshna

Øee«ethecemÙe ùoÙemhevoveb ®#elee lJeefÛe ~ properties of PittaDe®efÛe: heerlecet$elJeb mJesoYeeJeesÓuheJeefÖlee ~~ De. ù. efve. 13 Gatra Shool (Bodyache) - Due to vitiation of Mansa

Jwara (Fever) - Increased Ushna, lJekedâmheâesšveb …erJeveiee$emeeoew ce=odYe#eCeb Øes#eCeketâšMeesLe: ~Teekshna properties of PittaefJeCcet$eheerlelJeceLeeefJeheekeâes YeefJe<ÙelemlemÙe hegj:mejeefCe ~~

Shwasa - Vitiation of Rasa Mala- Kapha meg. G. 44/Yee. Øe./Ùees. j./ cee. efve. Vitiation of Sadhak Pitta in

Predromal signs and symptoms described in all the Samhita HrudayGranthas are mentioned below along with its possible Vitiation of Pranavaha Srotas - etiology. Dyspnoea?Hrutspandan (Palpitation) - Due to vitiation of Sadhak Gaurav - Due to Dhatvashrit Dosha, Pitta and Vyana Vayu Vitiation of Rasa Mala Kapha?Raukshya (Dryness) - Due to Rasakshaya Aruchi (Fatigue) - Vitiation of Rasa and Sadhak ?Swedabhava - Due to Rasakshaya Pitta ?Shrama, Saad - Due to Rasakshaya Pain as if being heated ?Aruchi - Due to Rasadushti or churning pain - Due to vitiation of Mansa?Peeta Vinmootra - Varna Akshikoota Shotha - Cardinal sign Vikruti due to vitiation of Greenish discolouration, Pitta loss of body hair, ?Agnimandya, Avipaka - Due loss of skin glow - Vitiation of Bhrajak Pittato Agni Vikruti Anger/ Irritation - Aggravation of Pitta?Twak Sphotan (Cracks/ Sheetadwesh - Due to Vyadhi Prabhavroughness of skin) – Due to Atinidra - Due to RasakshayaRasakshaya, absence of Pindikodweshtan - Vitiation of MansaSnigdhata Alpavak - Due to Rasakshaya?Stheevan – Due to Rasadushti, Rasa Mala – Along with these, Pain and weakness in lower back, thighs, Kapha Vruddhi legs (especially after exercise), Dhatu Gaurav, Shaithilya, ?Akshikutashotha (Periorbital Oja Guna Kshaya, Alparakta, Alpameda, Nissar, Indriya oedema) – Swelling around Shaithilya, Angamarda, Hruddravata, Sakthisaad etc. are eyes also seen in Pandu. Also the following signs and symptoms

of Rakta and Meda Dhatu Samanya Lakshan -

Kshaya are observed in All seers have mentioned almost similar signs and

Pandu. symptoms as stated below -

Lakshan Samprapti - jòesâÓcueefMeefMejØeerefle:Karnakshwed (Tinitus) - Dryness of ear wax efmejeMewefLeuÙe®#elee~ De. ù. met. 11Agnimandya (Anorexia) - Vitiation of Pachak Pitta

cesoefme mJeheveb ke⚟e: hueerÖes Je=efæ: Durbalata (Lethargy) - Due to Rasakshayake=âMee*dielee ~ De. ù. met. 11Sadan (Bodyache) - Due to Rasakshaya

Annadwesh (Nausea) - Due to vitiation of Rasa Affection towards cold and sour food items, laxity in blood

Punarnava Mandoor

?A Mandoor Kalpa acting on liver, Raktavardhak and Shothaghna

?Use of Dravyas like Punarnava increases Raktadhatvagni, thus improving functions of liver

?Effective in Pandu Vyadhi for improving quality & quantity of Rakta Dhatu

?Also useful in Kamala, Udar, Yakrut-Pleeha Vikar, Shotha, Krumi, Shwasa, Kasa etc.

?Dosage and Anupan - 1 to 2 Tab 2 -3 times a day along with Punarnavasava, Kumari Asava, Ghee or lukewarm water

Poorvaroopa / Lakshan4

Lohasava

?An Asava useful for increasing RBC count, made up of Raktavardhak Bhasma like 'Loha Bhasma' and other Agnideepak and Raktaprasadak Dravyas

?Effective in Agnideepan and improving liver function, thus useful in Pandu and related conditions

?Also useful in Gulma, Shotha, Shwasa, Kasa, Udar, Yakrut-Pleeha, Jeerna Jwara or Visham Jwara, Agnimandya, Menstrual disorders in case of females

Dosage and Anupan - 2 to 4 tsf (10 to 20 ml) twice a day after meal with equal amount of lukewarm water

Types of Pandu heeC[dJeeceÙeesÓ°æ&efJeOe: Øeefo°: he=Lekedâ mecemlewÙeg&ieheÛÛe oes<ew:~ meg. G. 44 – 4 heeC[gjesiee: mce=lee: heÃe JeeleefheòekeâhewâŒeÙe: ~ 4 Types – Ekadoshaj 3 + Tridoshaj 1

1) Vataj – Dark coloured eyes / conjunctiva, blackÛelegLe&: meefVeheelesve heÃecees Ye#eCeevce=o: ~~ Yee. Øe., cee. efve., Ùees. j.coloured prominent veins, blackish Charak Samhita and Ashtanga Hruday have described 5 discolouration of stool, urine, nails & facetypes of Pandu. Their signs and symptoms are mentioned

2) Pittaj – Yellowish discolouration of eyes / below. The signs and symptoms of Vyadhi differs according conjunctiva, yellowish coloured to its types. Thus, diagnosis of the disease can be made prominent veins, yellowish based on these signs and symptoms which ultimately makes discolouration of stool, urine, nails & facetreatment easy. It does not mean that we give symptomatic

3) Kaphaj – Pallor of eyes / conjunctiva, pale treatment. But, signs and symptoms enable us to coloured prominent veins, pale stool, understand the type and presentation of the disease and urine, nails and facethus can be treated accordingly as per predominance of

4)Sannipataj – mixedDosha. Though the soil causes Pandu by vitiating Dosha and thus it Vataj Pandu – Symptoms like blackish / pale discolouration, should be considered as Doshaj Bheda, it does not get cured dryness of the body, body ache, pain, pricking sensation, when treated as per Dosha predominance. Because it does tremors, pain in flanks and head, constipation, tastelessness not help in digestion of the soil responsible for obstruction in of mouth, swelling, distention of abdomen, loss of strength, the Srotas, it does not allow digestion and absorption of rest giddiness etc. are seen along with Paleness of skinof the substances. It disturbs the formation of Rasa Dhatu as Pittaj Pandu – Symptoms like yellowish / greenish well as successive Dhatus, thus resulting in loss of strength discolouration, fever, burning sensation, thirst, dizziness, of sense organs, physical strength and Oja due to lack of yellowish discolouration of urine and stool, perspiration, nourishment to Dhatu. It should be considered and studied affection for cold, anorexia, bitterness of mouth, disliking for as a separate entity. Acharyas like Bhavaprakash and Harita hot and sour food, belching with sour taste, burning etc. have described total 8 types of Pandu by including sensation in stomach, body odour, loose stools, fatigue, Kamala, Kumbhakamala and Haleemak along with five giddiness etc. are seentypes stated above. Whereas Madhav Nidan and Kaphaj Pandu – Symptoms like heaviness of body, Yogaratnakar say that Kamala etc. are three stages of excessive sleep, vomiting, pallor, excessive salivation, Pandu. Charakacharya has also considered Kamala as the goose bumps, fatigue, fainting, lethargy, breathing difficulty, condition arising in Pandu Vyadhi, when one consumes cough, laziness, tastelessness, speech deterioration, sore excessive amount of Hetus vitiating Pitta. throat, paleness of urine, excessive lubricated or dry

conjunctival secretions, affection towards pungent, dry and Pandu Upadrava -hot food, swelling, sweet taste in mouth etc. are seen GheõJeemles<eg De®efÛe: efheheemee Úefo&pJe&jes cetæ&®peeÓefivemeeo: ~

MeessheâmleLee keâC"ieleesÓyeuelJeb cetÛÚe&keäuecees ùÅeJeheer[ve§e ~~Sannipataja Pandu - Mixed sign and Sypmtoms Õeemeeeflemeeje®efÛekeâemecetÛÚe&le=šdÚefo&MetuepJejMeesheâoeneved ~

Mrudbhakshanjanya Pandu - leLeeÓefJeheekeâmJejYesomeeoeved peÙesod ÙeLeemJeb Øemeceer#Ùe MeeŒeced ~~ ce=odYe#eCeMetveieC[eef#eketâšYeüt: MetveheeVeeefYecesnve: ~ meg. G. 44ef›eâefcekeâes…esÓeflemeeÙexle ceueb meeme=kedâ keâheâeefvJeleced ~~ Yee. Øe., Ùees. j., ceeefveUpadrava (Complications) of Pandu Vyadhi are described in

ce=odYe#eCeeod YeJeslheeC[gmlevõeÓÓuemÙee efveheeref[le:~ the Sootra of Sushrut Samhita stated above which are mekeâemeÕeemeMetueelee&: meoeÓ®efÛemeceefvJele: ~~ Yee. Øe. tastelessness, thirst, vomitting, fever, sensation of pain, loss Ashtang Hruday stated salty taste of mouth instead of sweet of appetite, inflammation of throat, fatigue, giddiness, in Kaphaj Pandu. Sushrutacharya has mentioned following 4 palpitation, breathlessness, cough, loose motions, pain & types of Pandu. Mrudbhakshanjanya Pandu has been burning sensation, indigestion, sore throat etc. Other included in types according to the predominance of Dosha in Samhitas have mentioned only Shotha as an Upadrava of commentary of Dalhan, as it ultimately gives rise to vitiation Pandu Vyadhi. Ashtang Hruday has also advised to perform of Dosha. the treatment of Shotha while treating Pandu.

Types of Pandu, Signs & Symptoms 5

Punarnavasava

?An excellent Asava useful for Vrukka-Yakrut-Pleeha-Hruday made up of Shothaghna, Mootral and Hrudya Dravyas like Punarnava

?Extremely useful in Shotha caused due to Pandu

?Also useful in Udar, Mootraghat, Yakrut-Pleeha Vikar, Mootrakrucchra etc.

Dosage and Anupan -2 to 4 tsf (10 to 20 ml) twice a day after meal with equal amount of lukewarm water

Kantaloha Bhasma

?An excellent Raktavardhak, Balya & Rasayan Kalpa ?Helps increasing RBC count and improves

Pitta secretion by acting on liver?It reduces Dhatushaithilya and enhances the

strength of body and sense organs?Also effective in Yakrut Vikar, Kamala,

Prameha, Sangrahani, Shool, Napunsakata etc.

Dosage and Anupan - 125 to 250 mg twice a day with Ghee, milk or honey

Sadhya-Asadhyata - Ayurved Samhita Granthas have described Pandu with following signs and symptoms as Asadhya (incurable). •Slow onset, swelling (especially on extremities,

face, anal region, genitalia), Shosha of the middle part of body

•Loose motion with less amount of faecus and greenish coloured mucous, fever•Vomiting, thirst, fainting, unconsciousness•Weakness, damage of sense organs etc.

Yogaratnakar and Madhav Nidan have mentioned that, the patients with Pallor throughout body parts are not treatable. Apart from this, patients with pale teeth, nails, eyes as well as vision are also said Asadhya (incurable).

Pandu during pregnancy and in chiledren

GlmeeneYeeJeesÓefivemeeoes ®efOejmhe=ne Ûesefle~ keâe. met. 25 / 34Kashyap Samhita is the Grantha which explains Pandu among Garbhini Rogas in detail. Garbhini Paricharya, as described in Grantha when not followed properly can give rise to Pandu in Garbhini. The diet and routine of the mother provides nourishment to the foetus. Thus, special care should always be taken in case of Garbhini.

Garbhini Pandu should be treated properly in time. In Garbhini Pandu, symptoms like loss of activeness, anorexia and affection towards food increasing Rakta Dhatu are seen. Same way, Pandu Vyadhi in children of Ksheerapavastha (breast feeding) is also mentioned in Granthas. Charakacharya has mentioned Pandu Roga in children in Chikitsa Sthana Adhyaya 30 under the topic of Pitta Dushtajanya Stanyapaan which is as follows :-

hetJe&Jeled kegâefheles efheòes oewie&vOÙeb #eerjce=ÛÚefle~heeC[dJeeceÙemleled efheyele: keâeceuee Ûe YeJesefÛÚMees: ~~ Ûe. efÛe. 30

efheòeog°mlevÙeheeveeod yeeueeveeb heeC[gjesiees YeJeefle~ me #eerjpe: ... ~ keâe.meb.

efJeJeCe&iee$e: efmJeVe: mÙeeled le=<CeeuegefYe&VeefJešd efMeMeg: ~ efvelÙeceg<CeMejerj§e veeefYevevoefle leb mleveced ~~

Stanya which is vitiated due to Vikrut Pitta, appears of different colour in comparison with normal Stanya, which is disliked by the baby. In case if the baby ingests the milk, he suffers from discolouration of skin, excessive perspiration, excessive thirst, loose motions, fever etc.

Pitta Prakopak Ahara & Vihar done by the mother causes vitiation of Pitta Dosha. This vitiated Pitta Dosha causes vitiation of the Stanyavahi Sira resulting in Pittajanya Stanya Vikruti & foul smelling Stanya. Due to intake of such a Stanya, the baby suffers from Pandu or Kamala Vyadhi. In condition of Kamala, Punarnava Mandoor if given along with Ghee for licking purpose proves effective. Whereas, in the condition of Pandu, Tapyadi Loha is beneficial.

6 Pandu Roga Avastha

Krumikuthar Rasa?An excellent remedy for all types of Krumi?Beneficial in Intestinal worms & Krumi

responsible for Raktadushti?Useful in Severe pricking pain at abdomen

& anal region?Effective in skin diseases developed due

to Krumi like Eczema, Psoriasis, Vitiligo, Pimples, Arunshika, Dadru etc.

?Effective in conditions of Anaemia, Oedema, Giddiness, Headache, Excessive salivation developed due to presence of Krumi

Dosage & Anupan – 2 to 4 tabs twice or thrice a day with lukewarm water.

Laboratory Investigations for Anaemia -

CBC – Complete blood count ( Hb, Hct, WBC, Platelet count, RBC – MCV, MCH, RDW ), Peripheral blood smear examination ( for abnormalities in RBC, WBC & platelet )Secondary Investigations: Serum ferritin, vitamin B12, and RBC folate levelsHb electrophoresisBlood biochemistry for hepatic and renal functionsBone-marrow aspirationTrephine biopsy from bone marrowCoombs test, osmotic fragility, Ham s test, erythropoietin level, immunocytochemistry, cytogenetics etc.

Abhraloha?An excellent Raktavardhak Kalpa with the

combination of Abhrak and Loha Bhasma ?The presence of Abhrak Bhasma facilitates

rapid absorption of Loha Bhasma which increases Rasa & Rakta Dhatvagni

?A useful Rasayan Yog for Pandu Vyadhi as well as for other diseases of Rasa - Raktavaha Srotas

?Proven effective medicine in increasing the count and quality of RBC's

?Helps decrease Dhatukshaya and provides physical and mental strength

?Useful in all stages of females, from menarche to menopause

?Also useful in Pandu, Agnimandya, Yakrut Dourbalya, fatigue during post natal period, Raktalpata developed due to Kamala, Jeerna Jwara, Atisar etc.

Dosage and Anupan - 1 to 2 Tabs twice a day after meal with milk or lukewarm water

Pandu Chikitsa 7le$e heeC[dJeeceÙeer efmveiOeleer#Cew®OJee&vegueesefcekewâ: ~ 'ëuewef<cekesâ keâšg®#ees<Ceb' i. e. Katu, Ruksha and Ushna medicines

mebMeesOÙees ce=ogefYeefmleòewâ: keâeceueer leg efJejsÛevew: ~~ for Kaphaj Pandu, rest all line of treatments are same. 5) Shaman Chikitsa -leeYÙeeb mebMegækeâes…eYÙeeb heLÙeevÙeVeeefve oeheÙesled ~In case of less amount of Doshas, following medicinal Meeefueved meÙeJeieesOetceeved hegjeCeeved Ùet<emebefnleeved ~~preparations are mentioned :-

cegûe{keâercemetjw§e peebieuew§e jmewefn&lew: ~ ?Gomootra Haritaki, Mandoor Bhasma, Navayas Loha, ÙeLeeoes<eb efJeefMe°b Ûe leÙeesYez<epÙeceeÛejsled ~~ Ûe. efÛe. 16 Nisha Loha, Dhatri Loha, Yogaraj Rasayan, Shilajatu

Vatak, Punarnava Mandoor, Darvyadi Leha, Dhat ryava leha , Gaudar ish ta , Bee jakar ish ta , The Chikitsa Sootra of Pandu Vyadhi clearly mentions the Dhatryarishta, Lohasava, Phalatrikadi Kwath etc.Shodhan Karma – Vaman as well as Virechan. Shodhan

should be performed in Pandu Vyadhi only after Samyak 6) Upadrava Chikitsa - Snehan. After Samyak or proper Shodhan (Koshtha In all patients of Pandu, treatment of Shotha should also be Shuddhi), Shaman Chikitsa, Rasayan Chikitsa and performed along with treatment of Pandu as mentioned in Pathyanna are also indicated to avoid recurrence. all Samhita Granthas. Chikitsa Krama - heeC[gjesies<eg kegâMeue: Meesheâesòebâ Ûe ef›eâÙee›eâceced ~ De. ù. efÛe. 161) Snehan -

Sushrutacharya also mentions that if efforts are not made Before starting Shodhan Karma, patient of Pandu should

to perform the Shodhan repeatedly, vitiated Doshas left in be first subjected to Snehan by all means, so that the

the body due to improper excretion may give rise to Doshas staying at Shakha get channelised to Koshtha. It

swelling of the respective body organs. should include external (Bahya) Snehan i.e. Abhyanga as well as Abhyantar Snehapan. Panchagavya Ghruta, 7) Mrudbhakshanjanya Pandu Chikitsa - Mahatikta Ghrut, Kalyanak Ghrut, Dadimadi Ghrut, efveheeleÙesÛÚjerjeled leg ce=efòekeâeb Yeef#e leeb efYe<ekedâ ~Katukadi Ghrut, Pathya Ghrut, Danti Ghrut etc. are Ùegefòeâ%e: MeesOevewmleer#Cew: Øemeceer#Ùe yeueeyeueced ~~advised for Snehan.

MegækeâeÙemÙe meheeaef<e yeueOeeveeefve ÙeespeÙesled ~ Ûe. efÛe. 16All Samhita mention medicated Ghrut for Snehan in case Separate line of treatment is mentioned for this type of of Pandu Vyadhi, as this gets developed due to vitiation of Pandu Vyadhi having specific causative factor. Teekshna Doshas with predominence of Pitta. Sanshodhan is advised in Mrudbhakshanjanya Pandu to 2) Shodhan -clear the obstruction of the Srotas caused due to soil. But njsÛÛe oes<eeved yengMeesÓuhecee$eeved ÕeÙesefæ oes<es<Jeefleefveln&les<eg ~~ this Sanshodhan should be performed after proper

meg. G. 44 examination of the strength (Bala) of patient. Once In Pandu, Doshas accumulated in the Dhatu, Srotas and Shareer Shuddhi is achieved with Sanshodhan, Ghrut Aashay should be repeatedly taken out from the body in medicated with Balavardhak and Agnivardhak Aushadhi small amount with the help of procedures like Vaman, should be administered, in which Vyoshadi Ghrut, Virechan. If it is not performed repeatedly, Doshas left in Kesharadi Ghrut prove to be effective. the body due to improper excretion may give rise to In such condition, Nidan Parivarjan (Avoiding consumption swelling of the respective body organs. of causative factors) is also equally important. If patient For Vaman – Madanphal, Yashti etc. can be used. cannot resist the habit of eating soil, the soil triturated with For Virechan – Gomootra + milk, only milk, Danti, the medicines useful in getting rid of the Doshas caused by Gambhari, black resins, Nishottar etc. can be used. Mrudbhakshan should be given to him. It includes Pathya Ahara and Sansarjan Karma should be followed Vidanga, Ela, Ativisha, Nimba etc. after Shodhan. Also, this Mrudbhakshan can give rise to Krumi, which 3) Shesh Doshanashan - further causes Pandu Vyadhi. These patients should also

be treated for Krumi. meeOÙevleg heeC[dJeeceefÙeveb meceer#Ùe efmveiOeb Ie=lesveesOJe&ceOe§e Megæced ~mecheeoÙesled #eewõIe=leØeiee{wn&jerlekeâerÛetCe&ceÙew: ØeÙeesiew:~ meg. G. 44/ Yew. j. Sushrut Samhita mentions Haritaki Choorna with Ghrut and honey to get rid of the Doshas left. 4) Vishesh Chikitsa / Hetu Viparita Chikitsa -

Jeeeflekesâ mvesnYetefÙe…b, hewefòekesâ efleòeâMeerleueced ~ëuewef<cekesâ keâšgefleòeâes<Ceb, efJeefceßeb meeefVeheeeflekesâ ~~ Ûe. efÛe. 16Charakacharya advises In Vataj Pandu – Snigdha medicines In Pittaj Pandu – Tikta, Sheeta medicinesIn Kaphaj Pandu – Katu, Tikta and Ushna medicinesIn Sannipatik Pandu – Combination of medicines should be used. Ashtang Hruday has specifically mentioned

Tapyadi Loha

?An excellent Agnivardhak, Saptadhatuvardhak, Ojovardhak, Rasayan Kalpa for Raktadhatu containing Suvarnamakshik Bhasma, Roupya Bhasma, Mandoor Bhasma, Shuddha Shilajit etc.

?Effective in Pandu being Raktaprasadak?Also useful in Mrudbhakshanjanya Pandu,

Krumi, Hrudrog, Kamala, Twacha Rog, Amlapitta, Sravi Arsha and irregular menses

Dosage and Anupan - 1 to 2 tabs (125 – 250 mg) twice a day with Ghee, milk, honey or lukewarm water

8 Pandu Chikitsa / Pathya - Apathya

8) Rasayan Chikitsa - are Rasayan very useful in maintaining Sarata of Rasa - Rakta Dhatu. Pandu Vyadhi being mainly a Vyadhi of Rasavaha Srotas,

Rasayan Sevan is necessary to maintain the Sarata of Rasa Pathya - Dhatu and to avoid its improper functioning once the disease ÙeJeeieesOetceMeeuÙeVeb jmewpee&*dieuepew: MegYew:~is treated with Shodhan – Shaman etc. This provides cegûe{keâercemetjeowÙe: heeC[ew Yeespeveefce<Ùeles ~~strength to Rasadi Dhatus and thus helps to maintain the

health of the patient. Ahara : Yava, Godhoom, Shali Anna, Jangal Mansa, Mudga, Adhaki, Masoor, dates, black raisin, green leafy vegetables Yogaraj Rasayan is one of the best medicinal preparation for like Palak, Tandulaja, pomogranate, Amla etc.Pandu Vyadhi, as described in Charak Samhita. Tapyadi Vihar : RestLoha, Navayas Choorna, Shilajatvadi Vati and Shatavari

Kalpa, Chyavanprash etc. are also effective in Pandu. They Apathya -also maintain physical strength, complexion etc. along with JeefÖceeleheceeÙeemeceVeheeveb Ûe efheòeueced ~Pittashaman and Raktaprasadan properties. cewLegveb ›eâesOeceOJeeveb heeC[gjesieer meoe lÙepesled ~~ Ùees. j.Raktavardhak, Dhatushaithilyanashak and Lohayukta

Rasayan should be used as Raktalpata, Medalpata and Ahara : Excessive intake of salty, pungent and sour taste, hot Dhatushaithilya are the conditions arising in Pandu Vyadhi. & spicy foodstuffs causing Pitta PrakopaMandoor Kalpa, Abhrakyukta Kalpa, Suvarnamakshik etc. Vihar : Heat, sunlight, exertion, intercourse, anger, walking

Being physicians, it is necessary for us to understand the Samprapti of Pandu and it is expected of us to think about the ways of Samprapti Bhanga of Pandu, instead of trying only to increase RBC count. Are the efforts to raise RBC count really capable enough to cause Samprapti Bhanga? If the Chikitsa is said to be the total eradication of the disease, then is it not necessary for us to think more than this symptomatic approach of raising RBC count? If the chain of pathogenesis in Pandu is not broken, will these Increased number of red blood cells survive in the body? If not, then such treatment is of no use if the result does not last longer. Being Ayurvedic practitioners, is it not necessary for us to think about this? Isn't it incomplete to think only about RBC's while treating Pandu with Ayurvedic point of view?

Is it not necessary to think?

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