By

Shaila Gurappa Borannavar.

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D. (PANCHAKARMA)

In

PANCHAKARMA

Under the guidance of

Dr. Shivaramudu P.M.D. (Ayu)

And co-guidance of

Dr. Shashidhar.H. Doddamani.M.D. (Ayu)

Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College,

Gadag – 582103.

2006.

Clinical Evaluation of Virechana Therapy In The Management of Panduroga

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

hereby declare that this dissertation / thesis entitled

“Clinical Evaluation Of Virechana Therapy In The

Management Of Panduroga” is a bonafide and genuine

research work carried out by me under the guidance of

Dr.Shivaramudu P. M.D. (Ayu), Professor, Post-graduate department of

Panchakarma and co-guidance of Dr. Shashidhar. H. Doddamani.

M.D.(Ayu), Assistant Professor, Post graduate department of

Panchakarma.

Date:Place: Gadag.

I

Shaila Gurappa Borannavar

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “Clinical

Evaluation Of Virechana Therapy In The Management Of

Panduroga” is a bonafide research work done by Shaila Gurappa

Borannavar. in partial fulfillment of the requirement for the degree

of Ayurveda Vachaspathi. M.D. (Panchakarma).

Date:

Place: Gadag Dr. Shivaramudu P. M.D. (Ayu).

Professor

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION

This is to certify that the dissertation entitled “Clinical

Evaluation Of Virechana Therapy In The Management Of

Panduroga”is a bonafide research work done by Shaila Gurappa

Borannavar. under the guidance of Dr. Shivaramudu P. M.D. (Ayu), Prof.

Postgraduate department of Panchakarma and co-guidance of

Dr. Shashidhar. H. Doddamani, M.D. (Ayu), Assistant Professor, Post-

graduate department of Panchakarma.

Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil.

Professor & H.O.D, Principal.

Post graduate department of Panchakarma.

CERTIFICATE BY THE CO- GUIDE

This is to certify that the dissertation entitled “Clinical

Evaluation Of Virechana Therapy In The Management Of

Panduroga” is a bonafide research work done by Shaila Gurappa

Borannavar in partial fulfillment of the requirement for the degree

of Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).

Place:Gadag. Assistant Professor,

Post graduate Department of Panchakarma.

COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and dissemi-

nate this dissertation / thesis in print or electronic format for academic /

research purpose.

Date:

Place:Gadag.

© Rajiv Gandhi University of Health Sciences, Karnataka.

Shaila Gurappa Borannavar

I

Acknowledgement

I deserve my respectful greetings in the lotus feet of Jagadguru Shri. Abhinava

Shivanandmahaswamiji to his holiness and divine blessings.

I am highly indebted to honorable H.O.D. Dr. G. Purushottamacharyulu M.D.

(Ayu), PG Dept. of Panchakarma, for his valuable suggestions in the completion of this

work.

I express my obligation to respectful guide Dr. P. Shivaramudu Prof. Dept. of

Panchakarma P.G.S.&R.S. Gadag for his critical suggestions and expert guidance, which

made me to complete this work.

I am extremely greatful and obliged to my co-guide Dr. Shashidhar H.

Doddamani M.D. (Ayu), Dept. of Panchakarma, P.G.S.&R.S., Gadag for his guidance

and encouragement at every step of this work.

With profound sense of gratitude I express my sincere thanks to Dr. G.B. Patil,

the Principal, D.G.M.A.M.C., Gadag for his timely encouragement as well as providing

all necessary facilities for this research work.

I am extremely obliged to Dr. Santosh Belawadi M.D. (Ayu) Lecturer, PG

Department of Panchakarma, for his remarkable suggestions and support throughout this

study.

I express my sincere gratitude to Dr. V. Varadacharyulu, Dr. M.C. Patil, Dr.

Mulgund, Dr. K.S.R. Prasad, Dr. Dilip Kumar, Dr. R.V. Shettar, Dr. Kuber Sankh,

Dr. Girish Danappagoudar, Dr. Jagadish Mitti, Dr. Nidagundi for their constant

encouragement.

My modest gratitude to Dr. S.D.Yerageri, R.M.O. D.G.M.A.M.C.&H, Gadag,

Dr. U.V. Purad, Dr. K. S. Paraddi, Dr. S.H. Redder, Dr. S. A. Patil and other

undergraduate teachers for the their support in the clinical work.

II

My sincere gratitude to Shri. V. M. Mundinmani (Librarian), Shri. Surreban

for providing book facilities, and to Smt. Belawadi other office and hospital staff for

their kind support in my study.

I am thankful to Dr. P.S. Khona and Shri. B.S Tippanagouda (Lab. Tech.), who

extended their co-operation in the investigations and I also extend my sincere thanks to

Shri. Nandakumar for statistical analysis of the study.

My deep gratitude to all my college and friends Dr. Jairaj, Dr. Hugar, Dr.

Kendadmath, Dr. Chandramouleeswaran, Dr. Santosh, Dr. Varsha, Dr. Subin, Dr.

Febin, Dr. Sateesh, Dr. Akki, Dr. Vijay, Dr. Biradar, Dr. Hakkandi, Dr. Ashwindev,

Dr. Madhushri, Dr. Devendrappa, Dr. Kalmesh, Dr. Shibaprasad, Dr. Prasanna,

Dr. Veena, Dr. Bani, Dr. Mangala, Dr. Bhingi, Dr. Sunita, Dr. Sajjanar, Dr.

Kalmath, Dr. Venkareddy, Dr. Meenakshi, Dr. Kumbar, Dr. Udaykumar Dr.

Ratnakumar, Dr. Shakuntala Dr. Sobagin, Dr. Shivaleela, Dr. Anitha, Dr. Suvarna,

Dr. Jayashree, Dr. Ashwini and other PG scholars for their timely help.

I extend my gratefulness and sincere obligations to my friends Dr. Pradeep A.,

Dr. B. Ganti, Dr. Nikhila and Dr. Seema P., in spite of their busy schedule they have

given me kind suggestions and support to complete this work.

My heartfelt gratitude to all my sisters and their families, especially Shri. B.

Mulawad (Lecturer) and Mr. Mahantesh for their constant support and encouragement

throughout my currier.

I acknowledge my patients for their constant participation in this clinical trial and

I extend my thanks to all persons who ever helped me directly or indirectly with

apologies for my inability to identify them individually.

Finally, I dedicate this work whole to my respected parents Mr. Gurappa

Borannavar & Mrs. Ningamma B., for their wholehearted inspiration and support to

fulfill this dream.

Date :

Shaila G. Borannavar. Place : Gadag.

III

Abbreviations

Ah – Ashtanga Hridaya.

As – Ashtanga Sangraha.

AT – After treatment.

AV – After Virechana.

BT – Before Treatment.

BV – Bhavaprakasha.

Ch – Charaka.

GIT – Gastrointestinal tract.

GR – Good response.

Ha – Harita Samhita.

IDA – Iron deficiency Anaemia.

MN – Madhava Nidana.

MR – Moderate Response.

NR – Not responded.

PR – Poor responded.

SS – Sharangadhara Samhita.

Su – Sushruta Samhita.

Va – Vagbhata.

VG – Vyoshadi Gutika.

Yr – Yoga Ratnakara.

IV

Abstract

Background

Panchakarma is popular term used for shodhana Chikitsa, which can give

satisfactory results in chronic diseases (Chirakari vyadhis) adopted in bahudoshavastha.

Virechana is one among them, which eliminates vitiated doshas through adhomarga i.e.

Guda. In this especially ama pakwashayagata doshas are eliminating. Globally, 30% of

total populations are anaemic and half of these some 600 million people have iron

deficiency. Panduroga is a santarpanajanya vyadhi, where pittadosha plays major role in

pathogenesis. Hence, Virechana is most appropriate shodhana therapy. Vyoshadi Gutika

is upakalpa of Trivrit indicated in Panduroga and can be considered as Sukha Virechaka.

Objective

The present study was planned with following aims and objectives –

01. To evaluate the effect of Virechana therapy in Panduroga.

02. To evaluate the effect of Virechana karma with Vyoshadi Gutika in

Panduroga.

Methods

It is single group “An observational study” where the patients having symptoms

of Panduroga were selected and classical Virechana therapy was administered –

The treatment contains the following steps –

01. Deepana pachana with Trikatu churna 3-6 gms thrice daily before food, till the

appearance of Nirama lakshanas.

02. Snehapana with “Dadima Ghrita” in arohana vidhi, till the samyak snigdha

lakshanas are seen.

03. Abhyanga with murchita tile taila followed by mridu sweda (Ushna jala snana).

04. Virechana with “Vyoshadi Gutika” 35-45 gms along with sheetajala as anupana.

V

05. Samsarjana karma was followed for 3-5 days depending upon the shuddhi

achieved.

06. Follow up study was done for 15 days. During these period patients were advised

to follow the pathya apathya mentioned in Panduroga.

Assessment criteria

Subjective parameter – The classical symptoms of Panduroga i.e. “Panduta”,

“Arohanayasa”, “Dourbalya”, “Bhrama” and Agnimandya.

Objective parameter – Haematological study, i.e. Hb is taken as main criteria, along

with that PCV, MCV, MCHC and Smear study was also assessed.

Results:

As a result of the proper administration of Virechana karma, it was noted that, it

gives long-lasting effect, which includes extraneous variable too. This can be appreciated

by comparing both subjective and subjective parameter taken before and after the

treatment. Among 30 patient who were taken for this study 9 patients (30%) were

responded good, 15 patients (50%) were moderately responded, whereas 6 patients (20%)

shown mild response.

Interpretation and Conclusion

Virechana is the most appropriate shodhana therapy in Panduroga. It alone can show

significant result if the Pathya apathya is followed properly.

Key words – Shodhana karma; Virechana therapy; Panduroga; Anaemia; Iron deficiency Anaemia; Haemoglobin; Trikatu churna; Dadima Ghrita; Vyoshadi Gutika.

VI

TABLE OF CONTENTS Chapters Page No.

1. Introduction 1-3

2. Objectives 4-5

3. Review of literature 6-67

4. Methodology 68-81

5. Results 82-114

6. Discussion 115-127

7. Conclusion 128-129

8. Summary 130-131

9. Bibliography 132-147

10. Annexure

VII

List of Tables Table No. Table showing the Page No.

01. Virechana yogyas 12 02. Virechana ayogyas 13 03. Samyak snigdha lakshanas 15 04. Virechana matra 16 05. Oushadha jeernajeerana lakshanas 17 06. Virechana vega nirnaya 18 07. Samyak virchana lakshanas 19 08. Virechana ayoga lakshanas 19 09. Virechana atiyoga lakshanas 20 10. Aharaja Nidana of Panduroga 29 11. Viharaja Nidana of Panduroga 30 12. Poorvarupa of Panduroga 31 13. Samanya lakshnas of Panduroga 32 14. Classification of Panduroga 33 15. Lakshanas of vataja Panduroga 33 16. Lakshanas of pittaja Panduroga 34 17. Lakshanas of kaphaja Panduroga 34 18. Lakshanas of Mrit bhakshanajanya Panduroga 36 19. Properties and ingredients of Trikatu churna 69 20. Properties and ingredients of Tila taila 69 21. Properties and ingredients of Dadima ghrita 70 22. Properties and ingredients of Vyoshadi gutika 71-72 23. Status of the patients of present study 82 24. Distribution of patients by age and response 82 25. Distribution of patients by sex and response 84 26. Distribution of patients by religion and response 85 27. Distribution of patients by occupation and response 86 28. Distribution of patients by socio-economical status and response 87 29. Distribution of patients by marital status and response 88 30. Distribution of patients by food habits and response 89 31. Distribution of patients by treatment history and response 90 32. Distribution of patients by prakriti and response 91 33. Distribution of patients by vyasana and response 92 34. Distribution of patients by koshta and response 93 35. Distribution of patients by agni and response 94 36. Distribution of patients by Nidana and response 95 37. Distribution of patients by incidence of lakshanas and response 99 38. Distribution of patients by type of Panduroga and response 100 39. Distribution of patients by snehapana and response 101 40. Distribution of patients by samyak snigdha lakshanas & response 102 41. Distribution of patients by number of Vegas and response 104 42. Distribution of patients by incidence of Maniki and response 105 43. Distribution of patients by incidence of Antaki and response 106

VIII

44. Distribution of patients by laingiki shuddhi and response 107 45. Distribution of patients by type of shuddhi and response 108 46. Overall assessment 109 47. The subjective parameters 110 48. The objective parameters 111 49. Distribution of patients by treatment protocol and observations 112-113 50. The statistical results 114

List of Graphs Graph No. Graph showing the Page No.

01. Age incidence and response 83 02. Sex incidence and response 84 03. Religion incidence and response 85 04. Occupation incidence and response 86 05. Socio-economical status incidence and response 87 06. Marital status and response 88 07. Food habits and response 89 08. Treatment history and response 90 09. Prakriti and response 91 10. Vyasana and response 92 11. Koshta and response 93 12. Agni and response 94 13. Aharaja Nidana and response 96 14. Viharaja Nidana and response 97 15. Manasika Nidana and response 98 16. Lakshana of Panduroga and response 99 17. Type of Panduroga and response 100 18. Snehapana and response 101 19. Samyak snigdha lakshana and response 103 20. Incidence of vegiki and response 104 21. Incidence of manaki and response 105 22. Incidence of antaki and response 106 23. Incidence of laingiki and response 107 24. Type of shuddhi and response 108 25. Overall assessment 109

List of photographs Photo No. Photographs Showing the Page No. 01. Drugs used in the study 69 02. Ingredients of Dadima Ghrita 69 03. Vyoshadi Gutika and its ingredients 71 List of flow charts. Chart No. Charts Showing the Page No 01. Samprapti of Panduroga 37 02. Erythropoiesis 62

INTRODUCTION

yurveda the cultural heritage of Indian civilization is not only a medicinal science

but also a full-fledged science consisting of social, spiritual, environmental,

psychological well-being and allied branches essential to lead healthy and happy life.

A

Ayurveda believes in supreme power (Atma). This concept is essential to know

the limitations of human efforts and to accept the existence of things beyond the

perception of our sence.

“Ayu” means life, which is proper combination of Shareera, Indriya, Satwa and

Atma. Veda means knowledge. Ayurveda provides not only curative measures but also

preventive principals for healthy and long life. Restoration of dhosha, dhatu and mala to a

state of equilibrium is the main aim of chikitsa in Ayurveda and it also gives equal

importance to Prasanna, Atma, Indriya and Manas i.e. Manasika Swasthya.

The brimhana and langhana are the two types of treatment modalities mentioned

in the classics1 and this langhana classified into shodhana and shamana, where shodhana

can be considered as Panchakarma therapies2.

The procedure by which the vitiated doshas are get eliminated from the body is

called shodhana3. It is five in number viz. Vamana, Virechana, Vasti, Nasya and

Raktamokshana4. This purification may be either transmuscosal or transdermal.

Panchakarma can adopt as a part of Chikitsa, prior measures for Rasayana chikitsa and

for Swasthavritta palana as well.

Virechana is specially indicated for pitta dosha, pitta dosha associated with kapha

dosha and also pitta sthanshrita kapha doshajanita conditions. Along with this virechana

is beneficial in vataja and raktaja disorders too.

Introduction 1

“Na Tesham Punarudbhavaha” indicates importance of Panchakarma i.e.

diseases treated with Panchakarma are having less chances of reoccurrence by prohibiting

the aggravation of doshas5.

Panduroga is mentioned in Brihattrayi, Laghutrayi, and other classical texts. This

is a pitta pradhana tridoshaja vyadhi in which rasa and rakta are mainly affected.

Charaka opines that due to excess intake of pitta prakopaka tridosha prakopaka

ahara, viahara the vitiated doshas assumes sthanasamshraya in between tawk and mamsa

resulting in pandu, harita, and haridra varna to the skin. Hence, the disease is named as

Panduroga.

Panduroga can be correlated with “Anaemia” in modern medicine. It refers to a

state in which the level of haemoglobin in the blood is below the normal range

(M-14.0g/dl F-12.3g/dl) appropriate for the age and sex. It may occur as primary disease

or as associated condition with other diseases.

Incidence And Prevalence

Globally, 30% of the total world population are Anaemic and half these, some 600

million people have iron deficiency.

Iron deficiency Anaemia (IDA) is most prevalent nutritional problem in the world

today. Young children and women of reproductive age group especially pregnant and

lactating women are at greatest risk. Though prevalent in all countries, IDA is most

widespread in developing countries where prevalent of this disease may be as high as 60-

70% in pre-school children and 60-80% in pregnant women.

Introduction 2

Need for the study

The modern management of Anaemia is mainly oral therapy and parental therapy

for correcting iron deficiency. These are inspite of many advantages still remains

unsatisfactory. Oral therapy can cause nausea, abdominal discomfort, diarrhoea, and

constipation as side effects and it almost turns stool black, which is harmless side effect.

The adverse effect of parental therapy includes hypersensitive reactions, haemolysis,

hypotension, and circulatory collapse, vomiting and muscle pain. Blood transfusion,

which is said as emergency treatment, can rise in Hb up to 1gm with a single unit. But it

can also cause some complication like acute intravascular hemolytic reactions, febrile

non-hemolytic reactions and allergic reactions. Thus it is important to search to more

safe, cost effective therapy, which could be explored from the Auyrveda. Virechana is

one such therapy, which can give wonderful results in many diseases including

Panduroga. As pitta dosha plays a great role in samprapti of Panduroga. Virechana is the

best and most acceptable shodhana therapy.

Charaka has praised the importance of Vyoshadi Gutika in Kalpasthana which is

indicated in many disorders including Panduroga6 as it is a yoga of Trivirt, it can be

considered as best for Sukhavirechana.

In this study the patient suffering with lakshanas of Panduroga were administered

classical virechana therapy, with specially indicated Dadima Ghrita7 for Snehapana and

Vyoshadi Gutika8 for Virechana karma.

Introduction 3

OBJECTIVES

Even though many research works have been conducted on the effect of some

indigenous drugs on “Panduroga.” This study is intended to observe the beneficial effects

of Virechana in Panduroga as Panduroga.

Panduroga is pittapradhana tridoshaj vyadhi where rasa and rakta are mainly

affected. Virechana is main line of treatment for pittadosha and it is not viruddha Chikitsa

for kapha and vata dosha, which are associated in this disease. Panduroga is

santarpanajanya vyadhi where virechana a kind of apatarpana Chikitsa could give

benefical effects. Veirechana mainly acts on Pittadharakala, as Pittadharakala and

Majjadharakala are one and the same according acahrya Dalhana. So Virechana may

stimulates triggering points of the production the raktadhatu i.e. Haemopoietic system.

Vyoshadi Gutika is a upakalpa of Trivirtt can be considered as Sukhavirechaka

and is indicated in Panduroga. Its ingredients are easily available, method of preparation

is very easy and it is palatable too. Its ingredients contains properties like Rechaka,

Bhedana, Srotoshodhaka, Agnideepaka, Raktashodhaka, Krimighna, Yakrit uttejaka and

Vatanulomaka, which could be helpful in treating the pathogenesis of Panduroga.

So the objective of this study is –

01. To evaluate the effect of Virechana Therapy in Panduroga.

02. To evaluate the effect of Virechana karma with Vyoshadi Gutika. (Charka

Kalpasthana) in Panduroga.

Objectives 4

Research works done on Panduroga

01. Deshapande Swati S. – Clinical study of Panduroga and its Management with

Mandoora bhasma.

02. Pandey Shashi – Effect of Pathya ghrita in cases of Pandu.

03. Kottarshetti Irranna – The effect of Guda Nagaradi Vati in Panduroga.

04. Basavaraj R. – A Comparative study on the effect of Dhattriavaleha and

Kaseesa bhasma in Panduroaga w.s.r.t. to Iron deficiency

Anaemia.

05. Loba Zenica – Evaluation of the effect of shuddha Kaseesa and Loha

Bhasma in Panduroga w.s.r.t. Iron deficiency Anaemia –

A comparative study.

06. Jaiswal Vipal – Efficacy of Ashta Dashanga lepa in the management of

Panduroga.

07. Raka Shital F. – To Study the effect of Rasnapanchaka kashaya in

Amavastha of various diseases w.s.r.t. to Pandu.

08. Purani D. A. – A clinical study on the Management of Panduroga with

Yogaraja Rasayana.

Objectives 5

HISTORICAL REVIEW

Ayurveda, the most indigenous system of medicine has propagated treatment for

many diseases. The principles of treatment described in our ancient Auyrvedic texts still

hold good since ages.

Panduroga is a dreadful disease, which sticks all the age groups. It is therefore

essential to find out effective and harmless treatment of Panduroga and for that it is

necessary to look at ex-post factor where Panduroga has been described in minute details.

In a systemic enquire into the state of medical science in India. It may be pointed

out that the Brihattrayee’s earliest of medical literatures, which furnish us with detail

description of the disease Panduroga and Virechana therapy. For the sake of convenience

the history of Ayurveda can be derived as follows –

01. Vedic Period

02. Pauranika Period

03. Samhita Period

04. Sangraha Period

05. Modern Period

A. VEDIC PERIOD

In Vedic literature especially in Rigveda and “Atharvana veda we found the term

“Halima” and “Harita” which are observed to be correlative with Panduroga. The

treatment of the disease is also mentioned in both Vedas.

B. PURANA KALA

The word “Pandu” is available in Mahabharata when sage “Vyasa” intercourse

with “Ambilika” the windows of “Vichitra veerya”, she becomes pale with fear. That’s

why her son who born becomes pale (Pandu) colour and named as “Pandu”.

Historical review 6

In Garuda Purana there is a reference that Takra mixed with loha churna was

advocated in the treatment of Panduroga. Besides the above description, Pandu is also

available in Agnipurana, Valmiki Ramayana and Yogavasistha.

C. SAMHITA PERIOD

Charaka Samhita – In Charaka Smahita sutrasthana, it is mentioned about

Virechana dravya sangraha, Virechana yogas and its procedure9-11. In kalpasthana various

virechana kalpas have been explained12 where as in Siddhisthana, Virechana samyak

yoga, ayoga, atiyoga, Virechana yogyayogya, Virechana vyapat and their respective

treatment are mentioned.13-15

Panduroga is well elaborated in Charaka samhita Chikitsasthana 16th chapter16.

Sushruta Samhita – In sutrasthana different virechana dravyas including the

various preparations of Trivrit are mentioned17-18. In chikitsasthana, the procedure of

Virechana karma, samyak ayoga, atiyoga, vyapat and their treatment is mentioned19-20.

Panduroga is described in Sushruta samhita Uttaratantra 44th chapter.21

Ashtanga Hridaya – In Sutrasthana Virechana vidhi is explained22. In

Kalpasthana, Virechana yogas and vyapatas are mentioned.23-24

Panduroga Nidana is explained in Ashtanga Hridaya Nidanasthana 13th chapter25

and its management in chikitsasthana 16th chapter.26

D. SANGRAHA PERIOD

Virechana well explained in Ashtanga sangraha Sutrastana27, Kasyapa samhita

Siddisthana,28 Bhavaprakasha Purvakhanda29, Yogaratnakar Virechanaadhikara30 and

Chakradatta Virechanaadhikara.31

Historical review 7

Panduroga is described in Ashtanga sangraha Nidanasthana32 and Chikitsasthana,33

Kasyapa samhita Sutrasthana,34 Yogaratnakar Pandurogaadhikara,35 Bhavaprakahsa

Madyamakhanda,36 Madhavanidana,37 Chakradutta Pandurogaadhikara.38

E. MODERN PERIOD

Cathartics are used in modern medicine for the treatment. Different types of drugs

and their action are mentioned in Satuskar pharmacology.39

In this period so many commentators have discussed about Panduroga and they

correlated it with Anaemia. The word Anaemia was first appeared for medical use in

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

similarly with Panduroga).

Historical review 8

VIRECHANA KARMA

NIRUKTI AND PARIBHASHA

Virechana is described from the root –

Rich dhatu, Vi upasarga, Nich and Lout pratyaya are also take part in the derivation.

“Visheshena Rechayateeti” 1

It means “Mala Nissarana” i.e. elimination of malas through any of the route in

the body. But in Ayurveda the word virechana is used for indication of only the

elimination of malas through adhobhaga i.e. Guda (Anal route). Even in case of

Niruhavasti Malas are eliminating through Guda, but adhobhagaharana type of shodhana

is not producing here i.e. elimination of Aama pakwashayagata malas. Certain specific

terminology is used in Ayurveda to indicate the elimination of malas other than Guda eg.

Vamana, Shirovirechana.

“Tatradoshaharanam Adhobhagam Virechanam Sanjnyakam |” 2

The act of expelling vitiated doshas (malas) through adhobhaga is known as

virechana. Here Chakrapani commented adhobhaga means “Guda” 3.

“Vireko Mukhapeetam Gudamargenanta: sthetastha |

Doshasya Nirasaaranam Pittasya Paramaushadham ||”4

Virechana is the process in which the orally administered drug can bring the

vitiated doshas through adhomarga and it is special treatment for pittadosha.

“Virechanam Pittaharanam Shreshtam |”5

“Pitta Tu Virekam Shleshma Samsrushte Vaa Tatsthanagate Vaa Shleshmaneeti |” 6

Virechana Karma 9

Virechana is a specially indicated for pitta dosha, Pitta dosha associated with

kapha dosha and kapha dosha which is situated in pittasthana.

Mridu Virechana is the line of treatment for avarana vata vyadhies7. As we know

“Pittam Tu Swedaraktayo|”8 i.e. Pitta and rakta have got ashraya, ashrayee bhava

relation, thus Virechana can be employed as a treatment in vitiated rakta and its disorders.

PARYAYA

The synonyms are9

• Rechana

• Praskandana.

According to the Sanskrit – English dictionary purgative, cuthartic. Evacuant and

Apercent are the different meanings of Virechana10.

VIRECHANA DRAVYAS

Virechana dravyas will have all the properties of vamana dravyas i.e. Ushna,

Teekshna, Sukshma, Vyavayi, Vikashi, except Urdhobagahara in case of vamana and

Adhobagahar in Virechana. But unlike vamana, the Virechana dravyas consist

predominance of prithvi and jala mahabuthas, which show specific property of removing

the doshas through adhobhaga. i.e. Guda marga11.

Virechana Karma 10

TYPES OF ADHOBHAGAHARA KARMA

Acharya Sharangadhara has classified according to the action of the virechana

dravyas –

01. Anulomana12 – The drugs, which will digest (paka) the apakwa malas and bring

them to adhomarga by removing the bandhana. eg. Haritaki.

02. Sramsana13 – The drugs which expel the slishta malas (malas adhere to the

lumen of intestines) with out doing the paka. eg. Aragwadha.

03. Bhedana14 – The drugs, which disintegrates the Abaddha or Baddha or Pindita

forms of malas and then evacuating through adhomarga. eg Kutaki.

04. Rechana15 – The drugs which eliminates pakwa and apakwa malas by making

them in drava form through adhomarga. eg Trivritta.

There are certain drugs, which will help, in proper Virechana or which will

synergies the action of Virechana dravyas is known as Virechanopaga. The drugs

disciebed are Draksha, Kashmarya, Parushaka, Abhaya, Amalaki, Vibhitaki, Kuvala,

Badara, Karkandhu and Pilu16.

VIRECHANA YOGYA AND AYOGYA

As a first step in Virechana vidhi, one has to observe whether the patient is fit for

Virechana karma or not. For this Virechana yogyas and Virechana ayogya criteria is

given in the classics. Those who are fit for virechana should only be given with

virechana, otherwise it will leads to complications.

Virechana Karma 11

Virechana Yogya 17-19

Table No. 01. Showing the indication of Virechana Yogya conditions.

Sl. Virechana Yogya

Ch Su Va Sl. Virechana Yogya Ch Su Va

Pitta pradhana vyadhi Stree Roga 01. Jwara + + + 31. Stanya dosha - - + 02. Pandu + + + 32. Yoni dosha + + + 03. Kamala + - + Shalyapradhana vyadhi 04. Halimaka + - + 33. Arbuda + + - 05. Asyadaha + + - 34. Bhagandara + + + 06. Netradaha + + - 35. Arsha + + + 07. Guda &

Medradaha - + - 36. Galaganda + + -

08. Nasa and Karnadaha

- + - 37. Granthi + + +

Vata Pradhana vyadhis 38. Bradhna + + - 09. Shirashoola + + + 39. Dushta vrina - + + 10. Parshwashoola + + + 40. Mutraghata + + + 11. Gulma + - + 41. Shastrakshata - + - 12. Vatarakta + - + 42. Ksharagni dugdha - + - 13. Pakshaghata + + - Shalakya vyadhi 14. Pakwashaya ruja - + - 43. Timira + + +

Kapha pradhana vyadhi 44. Abhishyanda - + + 15. Prameha + + + 45. Kacha - + - 16. Netrasrava + - - 46. Akshipaka - + - 17. Asyasrava + - - Annavaha Srotas 18. Nasasrava + - - 47. Krimikoshta + + + 19. Shwasa + - + 48. Garavisha - + + 20. Kasa + - + 49. Visuchika + + - 21. Kshavathu + + + 50. Alasaka + + -

Tridosha vyadhis 51. Udara + - + 22. Kushta + + + 52. Arochaka + + - 23. Visarpa + + + 53. Avipaka + + - 24. Hridroga + + - 54. Vibandha - + +

Raktapradhana vyadhis 55. Anaha - + - 25. Pleeha + + + Pratimarga Chikitsa 26. Vyanga + - + 56. Urdhwaga Raktapitta + + + 27. Neelika + - - 57. Udavarta + - - 28. Visphotaka + + + 58. Chhardi + + +

Manasa roga 29. Unmada + - - 30. Apasmara + - -

Virechana Karma 12

Virechana Ayogya20-22

Table No. 02. Showing the indication of Virechana Ayogya conditions.

Sl. Virechana Ayoga Ch Su Va Sl. Virechana Ayoga Ch Su Va

Karma Asahanata 21. Bhayabheeta + - -

01. Vilambita + - - 22. Chintaprasakta + + -

02. Durbala + + + 23. Maithuna prasakta + - -

03. Durbalendriya + - - 24. Adhyayana prasakta + - -

04. Alpagni + + + 25. Vyayama prasakta + + +

05. Kshataksheena + + + 26. Shalyardita + - +

06. Shranta + + - Samavastha

07. Pipasita + + - 27. Nava pratishyaya - + -

08. Kshudita + + + 28. Nava jwara + + +

09. Bala + + + Gudagata Vyadhis

10. Vriddha + + - 29. Kshataguda + + -

11. Karma bhara Adhvahana + - + 30. Muktanala + - -

12. Atikrisha + - + Anya Vyadhis

13. Atisthula + + - 31 Madatyaya + + -

14. Darunakoshtita + + - 32. Adhmana + + -

15. Kshama + - + Marga virodhi vyadhi

16. Garbhini + + + 33. Adhoga raktapitta + + +

17. Navaprasuta - + + 34. Atisara - - +

18. Subhaga + - -

Some other Conditions

19. Atisnighda + + + 20. Atiruksha +

Virechana Karma 13

PROCEDURE OF VIRECHANA

Procedure of Virechana can be classified under three headings

Purvakarma

Pradhanakarma

Paschatakarma

Purva karma:

Sambar sangraha

Atura pariksha

Atura siddhata

Matra vinischaya

Sambar sangraha: The medicines and instruments useful for Snehana, Swedana,

Virechana and the treatment of Virechana vyapat must be collected prior to the

administration of Virechana therapy.

Atura pariksha:

Examiniation of the petient for yogya ayogya.

Deciding the Virechana matra depending on the Dosha, Atura bala, Bheshaja,

Kaala, Desha, Agni, Koshta, Shareera, Ahara, Satmya, Satwa, Prakriti, Vaya,

Saama avastha and Vikara23

Deciding the type of Sneha and Virechana yoga by considering vyadhyanukulata

and vyadhyanurupata

Specific drugs for Virechana.24(a)

Vata Pradhana - Trivrit + Saidhava + Shunthi + Kanji or Mamsarasa

Pitta Pradhana - Trivrit Choorna + Draksha Kwatha

Kapha Pradhana - Triphala Kwatha, Gomutra, Trikatu

Children between the - Draksha Rasa + Aragvadha Phala Majja (Age group of 4-12 years)24(b)

Virechana Karma 14

Atura siddhata:

Prior to Virechana Karma the patients can be administered with Pachana, Snehana

and Swedana procedures as a purvakarma

Pachana can be administered in the condition of Ama, till the appearance of

Nirama lakshanas

Snehapana should be followed in arohana vidhi, till the appearance of samyak

snigdha lakshanas, maximum duration will be 3 to 7 days.25

Samyak Snigdha Lakshanas26-28

Table No. 03. Showing the Samyak Snigdha Lakshanas.

Sl. Lakshanas Ch Su Va Sl. Lakshanas Ch Su Va

01. Vatanulomana + - + 07. Anga laghavata - + -

02. Agnideepti + + + 08. Twak snigdhata - + -

03. Purisha snigdhata + + + 09. Adhomarga sneha srava - + -

04. Asamhata varcha + + + 10. Klama - + +

05. Gatra mardavata + + - 11. Shaithilya - + -

06. Gatra snigdhata + + + 12. Snehodvega - - +

Snehaat Praskandanam Jantuhu Triratroparata Pibet |29

In case of Virechana, 3 days rest is mentioned after Snehapana. During these days

Abyanga, Swedana and Snigdha, Drava, Ushna bojana, Mamsarasa, Odana, Amlarsa

Phala is recommended.30 i.e. the food must not produce kaphavruddhi “Manda Kapha”

is the condition described for proper Virechana Karma.31

Matra vinischaya

Matra of Virechana drug should be in such a quantity that the desired effect of

Shodhana must be achieved with out causing ayoga and atiyoga lakshanas

Virechana Karma 15

Table No. 04. Showing the dosage of Virechana according to sharangadhara.32

Kalpana Heena Matra Madhyama Matra Uttama Matra

Kwatha 8 tolas 4 tolas 2 tolas

Kalka, Choorna

Modaka

4 tolas 2 tolas 1 tolas

Nature of Koshta and Virechana

Mrudvi Matra Mrudu koshte cha madhyama |

Krure Tikshana Mata Dravyair Mrudu Madhyama Tikshanakaihi ||

Acharya Sharandhra opiens that the dravya matra should be alpa, madhyama, uttama for

the person of Mrudu, Madhyama and Krura Koshta respectively.33 Sushruta also opins

the same. 34

Pradhana Karma:

Pradhana karma starts with administration of virechana dravyas till the stoppage

of virechana Vegas i.e. –

01. Virechana yoga sevana.

02. Atura paricharya and Nirikshana.

03. Vega nirnaya.

04. Observation of samyak yoga, ayoga and atiyoga lakshanas.

05. Virechana vyapat and Pratikara.

Virechana yoga sevana:

Before the administration of virechana yoga the physician must examine the

patients physical and mental health once again. Patient must have digested, the food

taken on previous day and must got sound sleep on the previous night.

Virechana Karma 16

Shleshma kaale Gate Jnyatwa Koshta Samyak Virechayeet |35

According to Vagbhata, the patient has to take virechana karma just after

shlesmakala. It can be understood as the time is so adjusted that the virechana should be

started during pittakala. The pittakala falls between 10.00 am to 2.00 pm. Hence, the time

and dose of the virechana dravya should be decided depending upon the koshta and

agnibalabala of the patient. Ushna or sheeta jala can be used as anupana in accordance

with Virechana yoga.

Atura paricharya and Nirikshana:

The vaidya must observe the lakshans of Jeernoushadha, Ajeernaoushadha, Hrit

dosha and vyapat.

Aushadha Jeernaajeerna Lakshana36-37

Table No. 05. Showing Aushadha jeernaajeerna lakshanas.

Sl. Aushadha jeerna lakshana Aushadha ajeerna lakshana

01. Vatanulomana Dourbalya

02. Swasthya Daha

03. Kshut Angasada

04. Pipasa Bhrama

05. Mana prasannata Moorchha

06. Indriya prasannata

07. Shuddha udgar

In case of ajeernaoushadha lakshanas, the Virechana drugs should not be given

immediately, as the drug may produce severe purgation i.e. Atiyoga. But in some cases if

the drug is digested, and there is no hrit dosha lakshanas, he should be given food, again

virechana oushadhi should be administered on the next day. Even then if the virechana

does not occur then the patient must be given proper snehana swedana once again and

then Virechana oushadhi can be administered after 10 days38.

Virechana Karma 17

Apart form the above lakshanas the hrit dosha lakshanas should also be taken into

consideration. In proper virechana there will be expulsion of mala, pitta and kapha Vata

in sequence, “Kaphantam Virechana” and appearance of daurbalyata and laghuta

indicates that doshas have properly eliminated.39

If virechana persists even after manifestation of Hrit dosha lakshanas then vamana

should be performed.40 If the Virechana Vega does not occur then instantaneously the

ushna jala pana, and swedana must be performed on pani, pada and udara.41

Vega Vinirnaya

For the purpose of observation of pravara, madhyama and avara shuddhi,

Chakrapni has given four types of criteria i.e. Laingiki, Antiki, Vegiki and Maniki, but

importance should be given to Laingiki shuddhi. For vega vinirnaya the physician have to

leave the first two-three malayukta Vegas, then counting should be done till kaphantam.

Table No. 06. Showing the Virechana vega vinirnaya.42

Sl. Vega vishaya Pravara Madhyama Avara

01. Vegiki 30 Vegas 20 Vegas 10 Vegas

02. Maniki 4 Prastha 3 Prastha 2 Prastha

03. Antaki Kaphantam

04. Laingiki Samyak Virechana Lakshanas

Virechana Karma 18

OBSERVATION OF SAMYAK YOGA, AYOGA AND ATIYOGA LAKSHANAS

Laingiki shuddhi lakshanas are given in the table. Thereafter the Ayoga and

Atiyoga lakshanas mentioned in the classics have been presented in tabular form.

Table No. 07. Showing the Samyak Lakshana of Virechana karma.43

Sl. Virechana Samyak Lakshana Ch Su Va

01. Srotovishuddhi + - -

02. Indriya prasada + + -

03. Laghuta + + -

04. Agnideepiti + - -

05. Anamayatwa + - -

06. Kramat Vit, Pitta, Kapha and Vata Nissarana + + -

07. Vatanulomana - + -

08. Absence of Ayoga, Atiyoga lakshanas - - +

Virechana Ayoga and Atiyoga Lakshanas

Table No. 08. Showing the Ayoga lakshanas of Virechana.44

Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va

01. Kapha prakopa + + + 10. Vata pratilomata + - -

02. Pitta prakopa + + + 11. Daha - + +

03. Vata prakopa + - - 12. Hridaya ashuddhi - + +

04. Agnimandya + + - 13. Kukshi ashuddhi - + +

05. Gourava + + - 14. Kandu - + +

06. Pratishyaya + - + 15. Vitsanga - + +

07. Tandra + - - 16. Mutrasanga - + -

08. Chhardi + - - 17. Pidaka - - +

09. Aruchi + + +

Virechana Karma 19

Table No. 09. Showing the Atiyoga lakshanas of Virechana.45

Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va

01. Kapha kshayaja

vikara

+ + - 12. Hikka + - -

02. Pittakshayaja

vikara

+ - - 13. Moorchha - - -

03. Vata kshayaja

vikara

+ - - 14. Gudabhrimsha - - -

04. Supti + - - 15. Shoola - + -

05. Angamarda + - - 16. Kapha, Pitta rahita Sweta,

lohita udaka nissaranam

- - +

06. Klama + - - 17. Mamsa dhavanavat

Udakasrava

- - +

07. Vepathu + - - 18. Medakhandavat - - +

08. Nidra + - - 19. Trishna - - +

09. Dourbalya + - - 20. Bhrama - - +

10. Tamapravesh + - - 21. Netra Praveshanam - - +

11. Unmad + - - 22. Raktakshayaja vikara + - -

Ahridya, durgandhita, adhika matra yukta virechana oushadhi and in kaphotklesha

ajeernavastha the administered Virechana oushadha may produce vamana.46

Paschat Karma

Regimens to be adopted after virechana karma till the patient is able to take

normal diet are known as paschat karma. Soon after the samyak virechana karma the agni

becomes imbalance state. Hence, the patient is not allowed to take normal diet, which can

cause further vitiation of agni. Hence, the peyadi samsarjana krama should be followed in

order to bring back the equilibrium in the state of agni.47

Virechana Karma 20

Three to seven days samsarjana krama is followed by administrating peya, vilepi,

akrita krita yusha and akrita krita mamsarasa depending upon the shuddhi achieved. But

in following conditions Tarpana should be administered instead of samsarjana viz.48 –

01. Pitta kapha parisrava.

02. Madatyaya.

03. Vatapitta prakriti.

In Tarpna, Swaccha Tarpana, in place of Peya and Ghana Tarpana in place of

Vilepi should be used according to Chakrapani.49

VIRECHANA VYAPAT

Improper conduction of Virechana leads to vyapats like50 –

01. Adhmana

02. Parikartika

03. Parisrava

04. Hridgraha

05. Angagraha

06. Jeevadana

07. Vibhrimsha51

08. Stambhana

09. Klama

Guda bhramsha

Sajnyanasha

Kandu

Sushruta has given 15 vyapats of virechana52 –

01. Vamana occurs with virechana

dravyas (Urdhwagati).

02. Virechana occurs with Vamana

dravyas(Adhogati)

03. Shesha oushadhitwam

04. Jeerna oushadhitwam

05. Heena dosha apahritatwam

06. Vata shoola

07. Ayoga

08. Atiyoga

09. Jeevadana

10. Adhmana

11. Parikartika

12. Parisrava

13. Pravahika

14. Hridyopasarana

15. Vibandha

Virechana Karma 21

As seen above, acharyas have clearly metioned the ayoga and atiyoga vyapat in

detail and their respective treatment.

VIRECHANA OUSHADHA KARMUKATA

The vamana and virechana dravyas posses similar properties like ushna, teekshna,

sukhma, vyavayi and vikashi gunas. Drugs will reach the hridaya by its veerya thereby it

enters into dhamanis, sthula and anu srotas of the body. The Vikashi guna is responsible

for quick absorption, due to ushna guna vishyanadana will be produced. Teekshna guna

does chhedana of samhata doshas and brings back them to koshta. Form there due to

prithwi and jala mahabhoota gunas and adhobhagahara prabhava the doshas get

eliminated through gudamarga. Both Virechana and Vaman oushadhas are having the

similer propereties exept Urdwabhagahara in Vamana, adhobhagahara in case of

Virechana dravyas and it is only because of Prabhava the Virechana drugs produces

Virechana karma.53

Sushruta added sara guna along with the ushnadi gunas and this sara guna act as

anulomana.54

Acharya charaka says, the drugs act not only due to its prabhava but also due to

its dravyatwa prabhava gunatwa prabhava and both dravyatwa and gunatwa prabhava.

And the factors mentioned here may change based on the different conditions. The effect

produced is karma. The factor responsible for manifestation of effect is veerya.55

Virechana Karma 22

MODERN CONCEPT OF LAXATIVES: 56

Laxatives are act through multiple mechanisms affecting the epithelial transfer,

directly or indirectly, leading to decreased sodium absorption and increase in chloride

secretion by intestinal epithelial cells.

These drugs are sometimes classified according to intensity of action as mild,

moderate or drastic. Laxative effect suggests the elimination of soft-formed stool without

gripping and without much loss of water. In large doses many laxatives promote

catharsis, which means purgation and passage of more fluid stools. Laxatives can be

classified according to their mechanism of action as follows:

I. Stimulant or Irritant Laxatives:

Antroquinone group – This acts by stimulation of large bowel and also probably

by inhibiting NaCl water absorption in the colon. eg. Cascara sagrada and senna.

Pharmacological actions: As these drugs act mainly on large bowel evacuation occurs 6

to 8 hours after their ingestion. Stools are usually semisolid in consistency and incidence

of griping is low.

Irritant oils – eg. Castor oil.

It is fixed oil obtained by expression of the seeds of Ricinus communis Linn.

Chemically, it is triglyceride of ricinoleic acid, an unsaturated hydroxy fatty acid. Castor

oil itself is nonirritant. When ingested, it is hydrolysed in the intestine by pancreatic

lipase to glycerol and ricinoleic acid. Ricinoleic acid acts as an irritant and produces

purgation.

Pharmacological actions : As ricinoleic acid acts on small intestine, it produces

copius liquid stools, with associated fluid loss. Colonic emptying may be so complete

that patient may not pass the stool for several days. The action is quicker than that of the

anthroquinone and is evident within two to tnree hours. It causes griping.

Virechana Karma 23

Miscallaneous – eg. Phenolphthalein bisacodyl, sodium picosufate.

Pharmacological actions : Mechanism of action is not known but the drug acts

as stimulant mainly on the large bowel after 6 to 8 hours and produces soft, semisolid

stools associated with a little griping. An interesting aspect of phenopthaline is that about

15% of the dose is absorbed, some of which is re-excreted in the bile. This enterohepatic

circulation of the drug causes prolongation of its laxative effects.

II. Osmotic laxatives

Certain salts when given orally are not much absorbed and are retained in the

gastrointestinal tract. Such preparations exert an osmotic effect and therefore hold

considerable amount of water, thus increasing the intestinal bulk. This acts as a

mechanical stimulus causing an increase in the intestinal motor activity and evacuation.

Pharmacological actions : these compounds act in the small as well as large

intestines and therefore produces a watery evacuation within 3 to 6 hours. Because of

their quick onset of action they are given early in the morning before breakfast. They do

not cause irritation and there is very little griping. Patients should be instructed to take

plenty of water along with these drugs since administration of hypertonic solution may

produce dehydration due to water extraction from the circulation.

III. Bulk laxatives – eg. Methyl cellulose, Agar agar, Ptantago seeds, Bran.

These are various natural or semisynthetic polysaccharides and cellulose

derivatives, which when orally are not absorbed and increase the indigestible residue.

These agents absorb water and swell up, thus providing the stimulus of mechanical

distention for evacuation.

Virechana Karma 24

Pharmacological actions: These agents act purely because of their physical

property. Their action is mild and is usually seen 12 to 36 hours after ingestion. They

produce evacuation of solid or semisolid stools without any irritation or griping. Some

agents also have lubricating properties. Usually, these drugs are administered at bed time.

IV. Emollient laxatives: eg: Liquid paraffin and Dioctyl sodium sulfosuccinate.

Liquid paraffin mineral oil most widely used emollient laxative. It consists of a

mixture of hydrocarbons obtained from petroleum given orally. It is not significantly

absorbed and exerts a softening and lubricating effect on faeces.

Pharmacological actions: It is mild in action and itself does not initiate

peristalsis. Because of its lubricant action, the straining during defaecation can be

avoided. It is usually given at bed time, but can be taken at any time of the day.

Virechana Karma 25

DISEASE REVIEW

NIRUKTI AND PARIBHASHA

In Ayurveda, different diseases are named on the basis of signs and symptoms,

the origin of the disease, location of exhibiting its symptoms. Here the disease Pandu is

named on the basis of “Varna.”

The word “Pandu” is derived form “Padi–Nashne” dhatu by adding “Ku”

Pratyaya to it. For Pandu specifically the Nashana will be of the Varna i.e. the colour,

which is said by acharya Charaka as “Vaivarnya.”1 Thus the derivation of the word

“Pandu” indicates the abnormal colouration of the body.

Pandustu Peetabhagardhaha Ketaki Dhuli Sannibham |2

Pandu is a mixture of shweta and peeta varna in equal proportions, which

resembles the colour of pollen grains of Ketaki flower.

Pandu Haridra haritaan Varnancha Vividham Stwachi |

Sa Pandurogaha Ityuktaha ||

Pandu Haridra Haritan Pandutwam Tesham Chaadhikam |

The disease in which, twacha becomes Pandu, Haridra, Harita varna is known as

Panduroga.3

Padutwenopalakshitaha Rogaha Pandurogaha |

The disease in which Pandubhava, Pandutwa or Panduvarna is more is known as

Panduroga.4

Disease Review 26

RELATION BETWEEN RAKTA, PITTA AND PANDU.

In describing the rupas of Panduroga, acharya charaka has described symptoms

like Vaivarnya, Ojogunakshayam, hataprabha, Alparakta nissara. Hence, it is necessary to

know the role of Raktadhatu and Pittadosha which play a predominant role in the

maintenance of the complexion of the body. Rakta has been considered as a key factor for

the Jeevana, and Poshanakarma of the body. According to Maharshi Sushruta,

Raktam Jeevam Iti Sthiti:|5

But, the proper functions of rakta can be expected only in its pure form as said by

acharya charaka.

Tadvishuddham Hi Rudhiram Balavarnasukhayusha |

Yunakti Pranianam Prana: Shonitam Hyunuvartate ||6

As per the classics, raktadhatu is derived from rasadhatu. Rasa is an aqueous

fluid. It is a transparent and colourless substance due to the predominance of

Jalamahabhoota and due to predominance of Teja mahabhoota it is reddish in colour.

Rasadhatu is sara of Shadrasayukta ahara called Poshya dhatu. When this poshya

dhatu undergoes pachana by agni derived from pitta, it transforms into raktadhatu. Due to

the action of ranjaka pitta on rasa, it gets transformed into reddish colour substance i.e.

Rakta. Acharya Sushruta has mentioned the main site of rakta is Yakrit and Pleeha.7

Ranjaka pitta is located in Yakrit and Pleeha, plays a major role in ranjana karma of

Rasadhatu. According to Vagbhata site of Rajaka pitta is amashaya.8

On the bases of above description it can be deducted that rakta depends on pitta,

which transforms rasa into rakta, and bala, varna, ayu depends on rakta.

Disease Review 27

Pandu is said as Pitta pradhana vyadhi.9 In all types of paittika disorders

obviously there will be impairment of pitta i.e. in either vriddhi or kshaya stage.

It can be said that pitta plays an important role in the formation of rasaraktadi

dhatus as agni is represented by pitta in body which brings about good and bad effects

according to its normal or abnormal state.10

When pachaka pitta gets vitiated and due to its adverse effect, the digestive

process gets disturbed thereby dhatu formation. Ranjaka pitta also plays vital role in

formation of rakta, hence its vitiation also affect the formation of rakta. The vitiation of

sadhaka pitta disturbs the functions of hridaya and rakta parisanchalana. Hence, the sthayi

dhatus are poorly nourished. As a result, due to rakta kshaya, Bhrajaka and Alochaka

pitta also becomes durbala in performing their normal functions. Hence, various

symptoms of pitta are observed in Panduroga.

Thus it can be inferred that pitta plays a vital role in manifestation of disease

Pandu.

Disease Review 28

NIDANA PANCHAKA

Disease can be diagnosed by the study of Nidana, Purvaroopa, Roopa, Upashaya

and Samprapti.

NIDANA11, 12.13

The different authors have explained many nidanas for manifestation of the

disease Pandu. For the sake of convenience it can be categorized under different groups.

A. Aharaja Nidana

Table No. 10. Showing the Aharaja Nidana of Panduroga.

Sl. Nidana Ch Su Va Sl. Nidana Ch Su Va

01. Amlarasa sevana + + + 08. Tilataila sevana + + -

02. Kshara seavnaa + - - 09. Madya sevana + - -

03. Lavana rasa sevana + + + 10. Mrit bhakshana + + -

04. Ati ushna bhojana + - - 11. Teeskhnahara sevana - + -

05. Viruddha bhojana + - - 12. Atikatu sevana - - +

06. Nishapava sevana + - - 13. Ati kashaya sevana - - +

07. Masha sevana + + -

Charaka mentioned Pandu in Santarpanajanya vyadhi.14 Above said nidanas are

causes for pitta pradhana tridoshas prakopa and Mandagni. Acharya Madhavakar,

Bhavaprakash, Yogaratnakar have followed the Susrutha’s version.15 These types of

ahara may lead to disturb in digestive and assimilative process, leading to Panduroga.

Disease Review 29

B. Viharaja Nidana

Table No. 11. Showing the Viharaja Nidana of Panduroga.

Sl. Nidana Ch Su Va Sl. Nidana Ch Su Va

01. Amlarasa sevana

+ + + Manasika factors

02. Kshara seavnaa + - - 11. Bhaya + - -

03. Lavana rasa sevana

+ + + 12. Krodha + - +

04. Ati ushna bhojana

+ - - 13. Kama + - +

05. Viruddha bhojana

+ - - Pratikarma Vaishamya

06. Nishapava sevana

+ - - 14. Snehatiyoga + - -

07. Masha sevana + + - 15. Vegavidharana in vamana karma

+ - -

Manasika factors 16. Amatisara sangaha + + -

08. Chinta + - - 17. Dushtaraktanigraha in Raktarsha

+ - -

09. Shoka + - - 18. Snehavibhrama + - -

Causes related to vihara deals with both physical and mental activities as well as

iatrogenic cause i.e. Pratikarma vaishamya.

C. Nidanarthakara Roga

Panduroga can manifest as secondary to some other disorders like –

Raktarbuda16

Asrgdhara17

Raktapitta18

Yakrit-pleeha roga19

Raktarsha20

Pleehodara21

Yakrutodara22

Pittaja Prameha23

All leads to either rakta kshaya due to bleeding or vikrita doshas which results in

Panduroga.

Disease Review 30

POORVAROOPA24, 25, 26

The Panduroga manifests with following prodromal signs and symptoms –

Table No. 12. Showing the Purvaroopa of Panduroga.

Sl. Purvaroopa

lakshana

Ch Su Va Sl. Purvaroopa

lakshana

Ch Su Va

01. Hritspandana + - + 08. Mritbhakshaneccha - + -

02. Rukshya + - + 09. Akshi kuta shotha - + -

03. Swedabhava + - + 10. Avipaka - + -

04. Shrama + - + 11. Aruchi - - +

05. Twacha sphutana - + - 12. Peetamutrata - + +

06. Sthivana - + - 13. Peeta purisha - + -

07. Gatrasada - + + 14. Alpa vanhita - - +

Madhavakara, Bhavaprakasha and Yogaratnakara have followed Sushruta’s

version.27

ROOPA

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

identified. These can be classified as –

01. Pratyatma lakshana (Cardinal sign & Symptom)

02. Samanya lakshana (General sign & Symptom)

03. Vishesha lakshana (Distinguisheing features of doshanubandha)

Pratyatma Lakshana:

Pandurvarna is considered as Pratyatma lakshana of Panduroga. This colour is

almost similar to pollens of Ketaki flower.

Disease Review 31

Samanya lakshana:

The Samanya lakshanas of Panduroga mentioned in the classics other than Panduta

can be considered as below –

Table No. 13. Showing the Samanya lakshanas of Panduroga.28,29

Sl. Roopa Ch Su Va Sl. Roopa Ch Su Va

01. Panduta + + + 13. Shwasa + - +

02. Karna kshweda + - + 14. Gaurava + - +

03. Hatanala + - + 15. Gatra peeda + - -

04. Daurbalya + - + 16. Shunakshikuta + - +

05. Sadana + - + 17. Harita varna + - -

06. Annadwesha + - + 18. Hataprabha + - +

07. Shrama + - + 19. Kopanatwa + - -

08. Bhrama + - + 20. Shishira dwesha + - +

09. Gatrashoola + - + 21. Nidralu + - -

10. Jwara + - + 22. Pindikodweshtana + - -

11. Aruchi + - + 23 Sheerna lomata + - -

12. Gatramadata + - -

Vishishta Rupa

The lakshanas which are specifying the involvement of particular doshas and

there by helpful in differential diagnosis of Panduroga.

The classification of Panduroga is made with reference to samanya samprapti.

Though the classification is made on the bases of involvement of particular dosha, the

prime factor involved is pitta dosha.30

Disease Review 32

Classification of Panduroga:31,32,33,34

Table No. 14. Showing the classification of Panduroga.

Sl. Prakara Ch Su Ah As BP YR MN

01. Vataja + + + + + + +

02. Pittaja + + + + + + +

03. Kaphaja + + + + + + +

04. Tridoshaja + + + + + + +

05. Mridbhakshnanajanya + - + + + + +

The description of vishishta rupa according to classification of Panduroga is

presented as follows –

Vataja Panduroga Lakshana:35

Table No. 15. Showing the Samanya lakshanas of Vataja Panduroga.

Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va

01. Krishna angata + - - 09. Toda + - +

02. Krishna nakhatwa - + - 10. Kampa + - +

03. Krishnekshanatwa - + - 11. Parshwaruk + - +

04. Krishna sira - + - 12. Shiroruk + - +

05. Krishna ananatwa - + - 13. Shopha + - +

06. Ruksha netrata - + - 14. Anaha + - +

07. Rukshangata + - - 15. Asya vairasya + - +

08. Angamarda + - - 16. Balakshaya + - +

Disease Review 33

Pittaja Panduroga lakshana 36

Table No. 16. Showing the Samanya lakshanas of Pittaja Panduroga.

Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va

01. Gatra peetata + - + 09. Amlodgara + - -

02. Haritabha + - + 10. Daurbalya + - -

03. Murcha + - + 11. Peeta mutrata + + -

04. Jwara + + + 12. Shosha + - -

05. Daha + - + 13. Peeta vitkata + + -

06. Trishna + - + 14. Bhinna Varchas + - -

07. Sheetakamata + - + 15. Katukasyata + - +

08. Sweda + - + 16. Tama + - +

Kaphaja Panduroga lakshana 37

Table No. 17. Showing the Samanya lakshanas of Kaphaja Panduroga.

Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va

01. Shwetavabhasata + - + 11. Shwayathu + - -

02. Shuklakshita - + + 12. Shukla mutra + + -

03. Shukla nakha - + + 13. Shukla mala + + -

04. Shukla ananatwa - + + 14 Tandra + - +

05. Gaurava + + - 15 Chhardi + - +

06. Sadana - - - 16 Praseka + - -

07. Murchha + - - 17 Lomaharsha + - +

08. Bhrama + - - 18 Klama + - -

09. Shwasa + - - 19 Kasa + - -

10. Alasya + - - 20 Aruchi + - -

Disease Review 34

Tridoshasja Panduroga lakshana

Vitiation of all the doshas causes severe degree of dhatushaithilya and dhatu

gauravata leading to dhatu and Oja kshaya.

The features of sannipataja pandu are explained only in Hareeta samhita. All other

authors have stated that it manifests due to the vitiation of all the doshas and considered

as asadhya type of Panduroga.

Hareeta Samhita38

01. Tandra

02. Alasya

03. Shotha

04. Vamana

05. Kasa

06. Hrillasa

07. Shosha

08. Vitbheda

09. Jwara

10. Kshudartata

11. Moha

12. Trishna

13. Klama

As per the opinion of Brihattrayee’s the lakshanas of Vataja, Pittaja and Kaphaja

Panduroga were seen severely in Tridoshaja Panduroga depending on their degree of

vitiation.39

Mridbhakshanajanya Pandu –

Acharya charaka40 and Vagbhata41 have explained Mridbhakshanajanya pandu.

Further, Madhavakara, Yogaratnakara and Bhavaprakashakar have also followed the

Charaka’s version.42 But Sushruta has not considered it separately. Here Mridbhakshana

is considered as a Nidana for Panduroga rather than an individual type.

The person who is addicted to consuming Mrid like Kashaya, Ushara

(Ksharanurasa), Madhura rasa will vitiates Vata, Pitta and Kapha dosha respectively. The

Mrid moreover, produces srotovarodha without undergoing pachana leading to Indriya

balahani and Teja, Veerya and Ojas kshaya. Thus manifesting Panduroga, which can

cause Bala, Varna and Agni nasha.

Disease Review 35

Mridbhakshanajanya Panduroga lakshana

Table No. 18. Showing the Samanya lakshanas of Mridbhakshanajanya Panduroga.

Sl. Lakshana Ch Va MN BP Yo

01. Shoonaganda + - + + +

02. Shoonakshikoota + - + + +

03. Shoona bhru + - + + +

04. Shoona pada + + + + +

05. Shoona nabhi + + + + +

06. Shoona mehana + + + + +

07. Krimikoshta + - + + +

08. Atisara + + + + +

09. Sasrik Mala Pravritti + + + + +

10. Kaphayukta malapravritti + + + + +

SAMPRAPTI

The causes of Panduroga that are explained under the heading of Nidana leads to

vitiation of Tridosha but however, pitta is dominating dosha irrespective of type of

Pandu.

Acharya Charaka and Vagbhata mention the detailed Samprapti of Panduroga.

The intake of pitta pradhana ahara in excess, pitta situated in hridaya aggravates, it is

propelled by aggravated (balina) vayu through dashadhamani that spreads all over the

body. The vitiated pitta affects in between twak and mamsa leads to vitiation of twak,

mamsa, vata, asrik, thereby produces various varna like Pandu, Haridra and Hareeta, due

to Panduvarna pradhanata it is called as “Panduroga”. 43,44

According to acharya Sushruta, indulgence of Nidana leads rakta pradushana that

causes vitiation in Twak causes the Pandubhava therefore it is called as “Panduroga”.45

Disease Review 36

Dhatu Dourbalya Nidana Sevana Agnidushti

Pradushya Raktam Prakopa of Pitta pradhana doshas Agnimandya

Hridaya Samvasthita Amavisha Utpatti

Vimarga gamana of pitta by vitiated by vayu

Twak Mamsantarashrita.

Kapha, Vata, Rakta, Twak, Mamsa dushti.

Rakta kshaya

Bala, varna, oja kshaya.

Vaivarnya

Samprapti of Panduroga

P a n d u r o g a

Disease Revuew37

UPADRAVA

If the patient continues to indulge in ahara and vihara, which are said to be the

Nidana of Panduroga– the doshas get further aggravation and thus produces upadrava.

Only Sushruta has mentioned complication of Panduroga.46. Viz,

Aruchi Pipasa Jwara

Chhardi Shiro ruja Agnisada

Shopha Abalatwa Murchha

Klama Hridaya peedana Swarabheda

Daha

SADHYASADHYATA47

For the prognosis of Panduroga authors have mentioned asadhya Panduroga

lakshanas are as follows –

Panduroga of long duration with excessive rukshata is not treatable.

If the patient has developed shotha after long duration and is having vision of

objects in yellow is not treatable.

If the patient passes Baddha and Alpamala with kapha and Hareeta varna is not

curable.

If the patient suffering from Atisara.

If the patient is deena, Shwetangayukta (Shwetavarna leepatanga).

If the patient is suffering from Chhardi, Moorchha, Trishna.

If the patient is having Panduvarna of Danta, Nakha and Netra.

Whose anta bhaga i.e, bahu, janga, shira are shothayukta and madhyabhaga is

durbala and vice versa.

Patients whose guda, sheeshna and muska are shothayukta.

Patient having recurrent attacks of Sangnya nasha.

Disease Review 38

CHIKITSA SUTRA

The first line of treatment in Panduroga is snehana followed with samshodhana by

means of teekshna vamana and virechana. After kostha shuddhi the patient shoud be

adopted with pathya ahara and vihara.48

According to acharya Sushruta the Chikitsa sutra for Panduroga is snehana

followed by vamana and virechana. For this acharya Dalhana opines that though

Urdhwashodhana (vamana) is contra-indicated, Mrudu vamana can be administered in

accordance with Ritu, Desha, Prakruti, Kaala, Shareera.49

Snehairupakramya snigdamatva virechayet |

First snehana should be specified with indicated snehas and there after virechana

should be followed.50

For Mrutbhakshanajanya Pandu the line of treatment is précised as Teekshna

shodhana in accordance with balabala, followed by snehapana to restore the strength.51

Dosha vishesha Chikitsa in Panduroga52

1. Vataja pandu – Sneha bhooyistha

2. Pittaja Pandu – Tikta sheetala prayoga.

3. Shleshmaja Pandu – Katu, Tikta, Ushna dravya prayoga.

4. Sannipataja Pandu – Vimishra Chikitsa prayoga.

5. Mritbhakshanajanya Pandu – Nidana parivarjana along with the doshika chikitsa.

Disease Review 39

SHAMANAUSHADHIS

In Pandurogadhikara a variety of Ghrita, Churna, Vati, Kashaya, Avaleha,

Asavaarishta Bhasma and other single drug preparations are described for the

management of all types of Panduroga.

Ghrita: Panchagavya ghrita, Kalyanaka ghrita, Mahatiktaka ghrita, Dadima

ghrita, Katukadya ghrita, Pathya ghrita, Danti ghrita, Draksha ghrita, Haridradi ghrita,

and Vyoshadi ghrita.

Churna: Navayasa churna, Tapyadi churna, Trivyushanadi churna, Triphala

churna, and Shunthi churna.

Vati: Mandura vataka, Punarnava mandura, Bibitakadi vataka, and Shilajatu

vataka.

Kashaya: Negrodadivarga kashaya, Triphala kashaya, Vishaladi phanta, Guduchi

kashaya.

Avaleha: Vidangadyaavaleha, Darvyadileha, Dhatraavaleha, Triphaladyaavaleha,

Yogaraj rasa, Pravaladyavaleha, Abhayavaleha and Ayorajovyoshadyavaleha.

Asavaarishta: Dhatryarishta, Goudarishta, Beejakarishta, Manduradyorishta,

Abhayarishta, Phalarishta, Bibhitakasava, and Lodhrasava.

Bhasma: Lohabhasma, Mandurabhasma, and Swarnamakshikabhasma.

Others: Suddha kasisa, Shuddha shilajatu, Shuddha gairika, Mandura, Pravala,

Mukta, Amalaki, Yashtimadhu, Chitrakamula, Guduchi Daruharidra, Nimba,

Swarnakhiri, Ikshu, Goghrita, and Takra.

Disease Review 40

PATHYAPATHYA53

Pathya

Generally for Pana and Bhojana Shali, Yavagu, Yusha, Godhuma, Madya,

Mamsarasa, Dugdha, Ghrita, Patola, Shaka, Draksha, Dadima, Kharjura, Amalaki and

Ikshurasa should be adviced.

Specially, for –

Vata - Laghupanchamula siddha Jala.

Pitta - Hribera, Shunthi sadhita ghrita.

Kapha - Arishta, Sidhu, Asava.

Tridosha - Takra.

Apathya

Agni, Aatapa, Aayasa, Pittakaraka annapana, Maithuna, Krodha, Adwa and other

factors, which are said to be the causes for Panduroga, should be avoided.

Disease Review 41

ANAEMIA1,2

Anaemia can be defined as a haemoglobin concentration in blood below the

normal range appropriate for the age and sex of the individuals. In adults, the lower

extreme of normal haemoglobin is taken as 14.0g/dl for males and 12.0g/dl for females.

A decrease in the oxygen carrying capacity of the blood is termed as “Anaemia.”

The haemoglobin content of the erythrocytes determines the oxygen carrying capacity.

Hence, a reduction in the blood haemoglobin level and in the number of circulating

erythrocytes are characteristics of Anaemia,

Although haemoglobin value is employed as the major parameter for determining

value is employed as the major parameter for determining whether or not Anaemia is

present, the red cell count, haematocrit (PCV) and absolute values of MCV, MCH, and

MCHC provide alternate means of assessing Anaemia.

Patho-physiology of Anaemia

Subnormal level of haemoglobin causes lowered oxygen carrying capacity of the

blood. This in turn initiates compensatory physiologic adaptations such as –

01. Increased release of oxygen from haemoglobin.

02. Increased blood flow to the tissues.

03. Maintenance of the blood volume.

04. Redistribution of blood flow to maintain the cerebral blood supply.

Tissues with high oxygen requirement such as the Heart, CVS, and the skeletal

muscles during exercise, bear the brunt of clinical effects of Anaemia.

Disease Review 42

Clinical features of Anaemia

The haemoglobin level at which symptoms and signs of anaemia develop depends

upon following factors –

01. The spread of onset of Anaemia – Rapidly progressive Anaemia causes more

symptoms than Anaemia of slow onset, as there is less time for physiological

adaptation.

02. The severity of Anaemia – Mild Anaemia produces no symptoms or signs but a

rapidly developing severe Anaemia may produce significant clinical features.

03. The age of the patient – The young patients due to good cardiovascular

compensation tolerate Anaemia quite well as compared to the elderly.

Symptoms

In symptomatic cases of Anaemia, the presenting features are tiredness, easy

fatiguability, generealised muscular weakness, lethargy and headache. In older patients

there may be symptoms of cardiac failure, angina pectoris, intermittent claudication,

confusion and visual disturbances.

Signs

A few general signs common to all types of Anaemia are as follows –

01. Pallor – Pallor is the most common and characteristic sign, which may be seen in

the mucous membranes, conjunctiva and skin.

02. Cardiovascular System – A hyperdynamic circulation may be present with

tachycardia, collapsing pulse, cardiomegaly, midsystolic flow murmur, dyspnoea

on exertion and in case of elderly congestive heart failure.

Disease Review 43

03. Central nervous system – The older patients may develop symptoms like attacks

of faintness, giddiness, headache, Tinnitus, drowsiness, numbness and tingling

sensation of the hands and feet.

04. Occular manifestations – Retenal haemorrhages may occur if there is associated

vascular disease or bleeding diathesis.

05. Reproductive system – Menstrual distribances such as amenorrhoea and

menorrhagia and loss of libido are some of the manifestations involving the

reproductive system in Anaemia subjects.

06. Renal System – Mild proteinuria and impaired concentrating capacity of the

kidney may occur in severe Anaemia.

07. Gastrointestinal system – Anorexia, flatulence, nausea, constipation and weight

loss may occur.

Investigations of the Anaemia subject

After obtaining the full medical history pertaining to different general and specific

signs and symptoms in order to confirm the presence of anaemia its type and its cause the

following plan of investigations is generally followed.

A. Haemoglobin estimation – The first and foremost investigation in any suspected

case of Anaemia is to carry out haemoglobin estimation. Several methods are

available, but most reliable and accurate is Cyanmethaemoglobin (HiCN) method

Drabkin soultionj and spectrophotometer. If the haemoglobin value is below the

lower limit of the normal range for particular age and sex, the patient is said to be

anaemic.

Disease Review 44

B. Peripheral blood film estimation – The haemoglobin estimation in invariably

followed by examination of peripheral blood film for morphologic features after

staining it with Romanowsky dyes (Leishman’s Staining). The following

abnormalities we can look for in the smear study.

a. Variation in size – Microcytosis (Iron deficiency anaemia)

Macrocytosis (Megaloblastic Anaemia)

Dimophic

b. Variation in shape – Poikilocytes.

c. Inadequate haemoglobin formulation – Hypochromasia.

d. Compensatory erythropoiesis

e. Miscellaneous changes

C. Red cell indices – An alternative method to diagnose and detect the severity of

anaemia is by measuring the red cell indices –

a. In iron deficiency and thalassaemia MCV, MCH and MCHC are reduced.

b. In Anaemia due to acute blood loss and haemolytic Anaemia MCH, MCV

and MCHC are all within normal limits.

c. In Megaloblastic Anaemias, MCV is raised above the normal value.

D. Leucocytes and platelet count – Measuring of Leucocytes and platelet count helps

to distinguish pure anaemia form pancytopenia in which red cells, granulocytes

and platelet counts are often elevated.

E. Reticulocyte count – reticulocyte count is done in each case of anaemia to assess

the marrow erythropoietic activity. In acute haemorrhage and in haemolysis, the

reticulocyte response is indicative of impaired marrow function.

Disease Review 45

F. Erythrocyte sedimentation Rate – The ESR is non-specific test used as a screening

test for anaemia. It usually gives a clue to the underlying organic disease but

Anaemia itself may also cause to rise in ESR.

G. Bone marrow examination – Bone marrow aspiration is done in cases where the

cause for anaemia is not obvious. In addition to these general tests, certain

specific tests are done in different types of anaemias.

Classification of Anaemia

A. Pathophysiologic

I. Anaemia due to impaired red cell production.

a. Acute post-haemorrhagic Anaemia.

b. Chronic blood loss.

II. Anaemia due to impaired red cell production.

a. Cytoplasmic maturation defects –

i. Deficient haem synthesis – Iron deficiency anaemia.

ii. Deficient globin synthesis – Thalassaemic syndromes.

b. Nuclear maturation defects – Vitamin B12 or folic acid deficiency and

Megaloblastic Anaemia.

c. Defect in stem cell proliferation and differentiation –

i. Aplastic Anaemia.

ii. Pure red cell aplasia.

d. Anaemia of chronic disorders.

e. Bone marrow infiltration.

f. Congenital Anaemia.

III. Anaemia due to increased red cell destruction (Haemolytic Anaemia)

Disease Review 46

B. Morphologic

I. Microcytic, hypochromic.

II. Normocytic, Normochromic.

III. Macrocytic, Normochromic.

Iron deficiency Anaemia

The commonest deficiency disorder present throughout the world is iron

deficiency, but its prevalence is higher in developing countries. The factors responsible

for iron deficiency in different populations are variable and are best understood in the

context of normal iron metabolism.

Iron metabolism

The amount of iron obtained form the diet should replace the losses form skin,

bowel and genitourinary tract. These losses together are about 1 mg daily in an adult male

or in non-menstruating female. While in menstruating woman there is an additional iron

loss of 0.5-1 mg daily.

The iron loss required for haemoglobin synthesis is derived form two primary

sources –

01. Ingestion of foods containing iron (e.g. Leafy vegetables, Beans, Meats, Liver, etc.)

02. Recycling of iron form senescent red cells.

Absorption

01. The average western diet contains 10-15 mg of iron out of which only 5-10% is

normally absorbed.

02. In pregnancy and in iron deficiency, the proportion of absorption is raised to 20-

30%.

Disease Review 47

03. The iron is absorbed mainly in the duodenum and proximal jejunum.

04. Iron from diet containing haem is better absorbed than non-haem iron.

05. Absorption of non-haem is enhanced by factors such as ascorbic acid (Vitamin

C), Citric acids, Sugar, Gastric secretions and Hydrochloric acid.

06. Iron absorption is impaired by factors like medicinal antacids, milk, pancreatic

secretions, phytates, phosphates, ethylene diamine tetra acetic acid (EDTA) and

tannates contained in tea.

07. Non-haem iron is released as ferrous or ferric form but is absorbed exclusively as

ferrous form. The iron balance in the body is maintained largely by regulating the

absorptive intake by intestinal mucosal cells, so called Mucosal block.

08. The factors, which determine this mucosal intelligence, are unknown. When the

demand for iron is increased there is increased iron absorption, while excessive

body stores of iron causes reduced intestinal iron absorption.

Distribution

In an adult iron is distributed in the body as under –

01. Haemoglobin – Present in the red cells, contains most of the body iron (65%).

02. Myoglobin – Comprises a small amount of iron in the muscles (35%).

03. Haem and Non-haem enzymes – eg. Cytochrome, Cutalase, peroxidase, succinic

dehydrogenase and falvoproteins constitute a fraction of total body iron (0.05%).

04. Transferrin bound iron – Circulates in the plasma and constitutes another fraction

of total body iron (0.5%).

All these forms of iron are in functional forms.

05. Ferritin and haemosiderin – These are the storage forms of excess iron (30%).

Thus, are stored in the mononuclear phagocytic cells of the spleen, liver and bone

marrow and in the parenchymal cells of the liver.

Disease Review 48

Iron transport and utilization

After absorption, iron circulates in the blood bound to beta globulin fraction,

siderophilin or transferrin. Transferrin is present almost exclusively in the plasma and

extra vascular space and serves to transport iron from the site of absorption and storage to

the areas of its utilization. The liver parenchymal cells are the major site of transferrin

synthesis.

The labile iron pool (mainly ferritin) is that part of the body iron which is readily

available for utilization of haemoglobin synthesis. Iron quickly enters this pool

01. After absorption form the intestines

02. After release form the RBC breakdown

03. Following parental injections.

If the amount entering this labile pool is in excess of needs, then it is transferred

into storage pool. The daily iron turnover has been estimated to be approximately 35 mg.

The major contribution to this 21 mg comes form the normal red cells

destruction. About 3 million red cells are destroyed every second. Iron released form

destroyed red cells is thus reutilized.

About 11 mg of iron is contributed by that fraction which is not used for

haemoglobin production during its stay in the marrow. While remaining 2-3 mg comes

form the storage sites, intestinal absorption and the extra cellular fluid.

Form these 35 mg of iron about 32 mg, enters the erthropoietic labile pool, a

poorly defined compartment, primarily in the bone, for erythropoiesis. Approximately

1mg of iron goes for storage and into extra cellular fluid each and about 1 mg is excreted,

mainly in urine and sweat.

Disease Review 49

Pathogenesis

Iron deficiency anaemia develops when the supply of iron is inadequate for the

requirement of haemoglobin synthesis. Initially, the negative iron balance is made good

by mobilization form the tissue stores so as to maintain haemoglobin synthesis. It is only

after the tissue stores of iron are exhausted that the supply of iron to the marrow becomes

insufficient for haemoglobin formation so that state of the following factors –

01. Increased blood loss.

02. Increased requirements.

03. Inadequate dietary intake.

04. Decreased intestinal absorption.

Etiology

I. Increased Blood Loss

01. Uterine e.g. Excessive menstruation in reproductive years, repeated miscarriage,

at onset of menarche, post menopausal uterine bleeding.

02. Gastrointestinal e.g. Peptic ulcer, haemorrhoids, hook worm infestation, cancer of

stomach and large bowel oeasophages varices, hiatus hernia, chronic aspirin

ingestion, uncreative colitis, diverticulosis.

03. Renal tract e.g. Haematuria, haemoglobinuria.

04. Nose e.g. Repeated apitaxis.

05. Lungs e.g. Haemoptysis.

II. Increased Requirements

01. Spurts of growth in infancy, childhood and adolescence.

02. Prematurity.

03. Pregnancy and lactation.

Disease Review 50

III. Inadequate Dietary Intake

01. Poor economic status.

02. Anorexia e.g. in pregnancy.

03. Elderly individuals due to poor dentition, apathy and financial constraints.

IV. Decreased Absorption

01. Parietal or total gastrectomy.

02. Aschlorhydria.

03. Intestinal malabsorption such as in coeliac disease.

Clinical features

Initially, there are usually no clinical abnormalities. But subsequently, inaddition

to features of undergoing disorders causing anaemia, the clinical consequences of iron

deficiency manifest in two ways – Anaemia itself and Epithelial tissue changes.

01. Anaemia – The onset of iron deficiency anaemia is generally slow. The usual

symptoms are of weakness, fatigue, dyspnoea on exertion, palpitations and pallor

of the skin. Mucous membranes and sclerae. Patients may have unusual dietary

cravings such as pica. Menorrhagia is a common symptom in iron deficient

women.

02. Epithelial tissue changes – Long standing chronic iron deficiency causes

epithelial tissue causes epithelial tissue changes in some patients. The changes

occur in nails (Koilonychia or spoon shaped nails), tongue (Atrophic glossitis),

mouth (Angular stomatitis) and oesophagus causing dysphagia form development

of thin webs at the postericoid area (Pulmmer – Vinson Syndrome).

Disease Review 51

Treatment

The management of iron deficiency anaemia consist of 2 essential principles –

01. Correction of disorder causing the anaemia – The underlying cause of iron

deficiency is established after thorough check-up and investigations. Appropriate

medical or preventive and surgical measures are instituted to correct the cause of

blood loss.

02. Correction of iron deficiency – This can be compensated by two ways –

a. Oral Therapy – Administration of oral salts such as ferrous sulfate, tablets

containing 60 mg of elements iron is administered thrice daily, but side effects

occurs like nausea, abdominal discomfort, diarrhoea.

b. Parental therapy – This therapy is indicated in cases who are intolerant to oral

iron therapy, in GIT disorders such as malabsorption. This is hazardous and

expensive when compared with oral administration. Total dose is calculated

by a simple formula multiplying the grams of haemoglobin below normal with

250 mg of elemental iron is required for each gram of deficit haemoglobin.

The adverse effects include hypersensitivity reactions, haemolysis,

hypertension, circulatory collapse, and vomiting and muscle pain.

Disease Review 52

SHAREERA

Stomach1

The stomach has the shape of an expanded “J”. The stomach performs 4 major

functions. Viz.

01. The bulk storage of the ingested food.

02. Disruption of chemical bonds in chemical materials through the action of acids

and enzymes.

03. Mechanical breakdown of ingested food.

04. Production of intrinsic factor, a glycoprotein whose presence in the digestive tract

is required for the absorption of the vitamin B12.

Regulation of Gastric phase –

The CNS, regulated by the short reflexes coordinated in the wall of stomach and

regulated by the digestive tract hormones can control the production of acids and

enzymes by the gastric mucous.

01. The cephahlic phase –

Function – Prepare stomach for arrival of food.

Duration – short. (minutes)

Mechanism – Neural via preganglionic fibers in vagus nerve and synapse in

submucosal plexus (by seeing, smell, taste or thoughts of food)

Actions – Primary – Increased volume of gastric juice by stimulating

mucous, enzyme and acid production.

Secondary – Stimulation of gastrin release by G cells.

Shareera 53

02. Gastric phase –

Enhance secretion started in cephalic phase, homogenizes and acidify the chyme.

It initiates the digestion of proteins by pepsin. Duration of the phase is long i.e. 3-4 hours.

Mechanism –

Neural – Short reflexes triggered by stimulation of stretch receptors as

stomach fills. There is also stimulation of chemo-receptors as PH increases.

Hormonal – Stimulation of gastrin release by G cells by

parasympathetic activity and presence of peptide and amino acids in chyme. Also the

release of histamine by mast cells as stomach fills. As a result there is an increased acid

and pepsinogen production, increased motility and initiation of mixing waves. The

mixing waves occur several times per minute and they gradually increase in intensity.

After an hour, the material with in the stomach is churning like the clothing in the

washing machine.

03. Intestinal phase –

The main function of this phase is controlled rate of chyme entry into duodenum.

The duration of this process is long. i.e. hours.

Mechanism –

Neural – short reflexes (entero-gastric reflex) triggered by the extension of

duodenum.

Hormonal – Primary – Stimulation of CCK, GIP, and secretin release by

presence of acid, carbohydrate and lipids.

Shareera 54

Secondary – Release of gastrin stimulated by presence of undigested proteins and

peptides and finally there is feed back inhibition of gastric acid and pepsinogen

production, reduction of gastric motility.

The intestinal phase of gastric secretion begins when chyme starts to enter the

small intestine. The intestinal face generally starts after several hours of mixing

contractions, when the wave of contraction begins sweeping down the length of the

stomach. Each time the pylorus contracts, a small quantity of chyme squits through the

pyloric sphincter. The purpose of intestinal phase is to control the rate of gastric

emptying and ensure that the secretary, digestive functions of the small intestine can

proceed with reasonable efficacy. The arrival of chyme in the small intestine also triggers

other neural and hormonal events that co-ordinate the activities of intestinal tract,

pancreas, liver, and gall bladder.

Small Intestine2

The stomach is a holding tank where food is saturated with gastric juices and

exposed to stomach acids and the digestive effects of pepsin. These are the primary steps,

for most of the digestive and absorption functions occur in the small intestine, where the

products of digestion are absorbed.

The mucosa of the small intestine produces only a few of the enzymes involved.

The pancreas provides digestive enzymes as well as buffers that assist in the

neutralization of acidic chyme. The liver and the gall bladder provide bile, a solution that

contains additional buffers and bile salts, compounds that facilitates digestion and

absorption of lipids.

Shareera 55

The small intestine averages 6 m. in length and has a diameter ranging from 4 cm

at the stomach and about 2.5 cm at the junction to the large intestine. It accompanies all

abdominal regions except the right and left hypochondriac regions. It has 3 subdivisions.

duodenum, jejunum and ileum.

Intestinal Movements

After chyme has arrived in the duodenum weak peristaltic contractions move it

slowly towards the jejunum. These contractions are mesenteric reflexes not under CNS

control. Their effects are limited to with in a few centimeters of the site of the original

stimulus. These short reflexes are controlled by motor neurons in the submucosal and

mesenteric plexus. In addition, some of smooth muscle cells contract periodically even

without stimulation, establishing a basic contractile rhythm that then spreads from cell to

cell.

The stimulation of the parasympathetic system increases the sensitivity of these

mesenteric reflexes and accelerates both local peristalsis and segmentation. More

elaborate reflexes coordinate activities along the entire length of small intestine. Two

reflexes are triggered by the stimulation of the stretch receptors in the stomach as it fills.

The gastro-enteric reflexes stimulates motility and secretion along the entire length of the

small intestine, the gastro-ilial reflex triggers the relaxation of the iliocecal valve. The net

result is that, the materials pass form small intestine to the large intestine. Thus the

gastro-enteric and the gastro-ilial reflexes accelerate movements along with small

intestine, the opposite effect of the entero-gastric reflex. Hormones released by the

digestive tract can enhance or suppress reflex responses.

Shareera 56

Large Intestine3

The horseshoe shaped large intestine begins at the end of the ilium and ends at the

anus. The large intestine lies inferior to the stomach and liver and almost completely

frames the small intestine. The major functions are –

01.Absorption of water and compactness of intestinal contents into faeces.

02. Absorption of important vitamins liberated by the bacterial action.

03. Storing of fecal material before defecation.

It has the following parts –

01. Caecum

02. Colon

03. Rectum

Movements of large intestine

The gastro-ilial and gastro-enteric reflexes move materials into the caecum at

mealtime. Movement from the caecum to the transverse colon occurs very slowly,

allowing hours for water absorption to convert the already thick material into a sludgy

paste. Peristaltic waves move material along the length of colon. Movements from the

transverse colon through the rest of the large intestine results form powerful peristaltic

contractions called “Mass movements” which occur a few times each day.

The stimulus is distention of the stomach and the duodenum and the commands

are relayed over the intestinal nerve plexus. The contractions force the fecal materials

into the rectum and produce the conscious urge to defecate.

Shareera 57

Defecation

The rectal chamber is usually empty except when one of those powerful peristaltic

contractions forces fecal material out of the sigmoid colon. Distention of the rectal wall

then triggers the defecation reflex.

The defecation reflex involves two positive feed back loops both are triggered by

stretch receptor stimulation in the walls of the rectum. The first loop is a shorter reflex

that triggers a series of peristaltic contractions in the rectum that moves the feces towards

the anus. The second loop is a long reflex coordinated by the sacral parasympathetic

system. This reflex stimulates mass movements that push the fecal material to the rectum

from the descending colon and the sigmoid colon.

Rectal stretch receptors also trigger two reflexes important to the voluntary

control of defecation.

01. Visceral reflex –

Mediated by the parasympathetic innervations with in the pelvic nerves. This

reflex causes the relaxation of the internal anal sphincter, a smooth muscle sphincter that

controls the movements of the feces into the anorectal canal.

02. Somatic reflex –

That stimulates the immediate contraction of the external anal sphincter. The

elimination of the feces requires that both the internal and external anal sphincter to be

relaxed, but these reflexes open the internal sphincter and close the external sphincter.

The urge to defecate usually develops when rectal pressure reaches about 15 mm of Hg.

When it exceeds 55 mm of Hg external sphincter will relax and the defecation occurs.

Shareera 58

When we consider the pathogenesis of Panduroga, we must think of Rasavaha

srotas, Raktavaha srotas and twacha which shows the characteristics of this disease i.e.

“Panduta”

Rasavaha Srotas

The rasavaha srotas is the first dhatu to be developed form ahararasa and it

nourishes all tissues of the body. Therefore, there is no space in the body, which rasa

cannot pervade. The ahararasa is produced in annavaha srotas from the completely

digested food and absorbed through the wall of the annavaha srotas. All nutrients join

together in hridaya (Thorasic heart) qualifying it as rasadhatu and it is the same organ

which ejects the rasa into circulation, triggered by the vyanavata.

Since the hridaya is the rasasthana, it is also the moola of rasavaha srotas.

Charaka added the ten dhamanees that emits from hridaya.4 According to Sushruta,

hridaya and rasavahini dhamanis are the moolas.5 Hridaya is stated as the seat of rakta

and other fluids which are capable of circulation in the body.6

Since, the preenana and jeevana kriyas are esenetial for the maintenance of life

and rakta is the nearest dhatu to rasa. They both circulate together, but because of the

inability of cellular component (which carries raktamsha) of the raktadhatu to enter all

srotases the rasa proceeds further carrying the nutrients.7 Therefore, hridaya and

rasavahini dhamanee’s should be considered as the moolas of rasavaha srotases.

Shareera 59

Raktavaha srotas

In the process of the dhatu parnamana, raktadhatu is stated to be developed form

rasadhatu.8 There are three pittas which participate in the formation of raktadhatu. Viz. –

01. Rasagni.

02. Raktagni

03. Ranjakagni

Raktadhatu is cellular in nature and the raktamsha which carries the vishishta

vayu known as “Prana”, with the function of jeevanakriya is located in these cells. The

raktamsha impairs colour to the rakta but the introducing this raktamsha into the

raktajeevaparamanus is the function of Ranjaka pitta.

According to Sushruta, the ranjakapitta is located in yakrit and pleeha.9 Vegbhata

considered amashaya is the seat of ranjakapitta.10

The above is only rough idea about the production of rakta as explained in our

text and this formation indicates that the raktadhatu is produced in yakrit and pleeha.

Here it is essential to look into the modern science regarding the production of red blood

cells.

The liver and spleen are responsible for red blood cells production in the

gestational age. Then during the latter part of gestation and after birth, red blood cells are

produced exclusively by the bone marrow, of all bones until a person is 5 years old. After

approximately the age of 20 years, the marrow of long bones, except for the proximal

portion of the humeri and tibial, becomes quite fatty and there is no more production of

red blood cells. Beyond this age most red cells are produced in the marrow of the

membranous bones, such as vertebrae, sternum, ribs and iliac bones. Even in these bones

the marrow becomes less productive as age advances.

Shareera 60

There is no direct reference in the samhitas to the part played by Majja (Bone

marrow), in the formation of rakta. But, there is a reference in Sushruta samhita stating

that “Sarakta Medas”, corresponding to the red bone marrow. Majja is present inside the

sthulasthis (larger bones). The substances present within other bones should be

considered as Saraktam medas (Medas mixed with the blood).11

Sushruta bestows importance of rakta equal to the three humours, that the body is

supported or maintained by the rakta.12 The most important function of rakta is

jeevanakriya i.e. sustains life.13 The word “Prananuvartam” also indicates that it carries

vishishta vayu “Prana”.

In panduroga (Anaemia) where there is deficient production of raktadhatu is the

main pathological event, all authorities of Ayurveda have invariably prescribed the

formulation containing iron. Thereby recognizing the importance of iron in the

production of raktadhatu. When iron is absorbed form the small intestines, it immediately

combines with a beta globulin to form transferrin and transported in the blood plasma.

About 60% of excess iron is stored in the liver cells, to be released whenever necessary to

the body.

There are a few components of vitamin B, which are needed for the formation of

red blood cells. Cyanocobalamin (Vit.B12) is required for the maturation of the red blood

cells. The most common cause of maturation failure is not due to due lack of Vit.B12 in

the diet but failure to absorb Vit.B12 form gastrointestinal tract. The intrinsic factors,

which are secreted by the parietal cells of the gastric glands (Amashaya) combines with

Vit. B12 of the food and makes this vitamin available for absorption. Once Vit. B12 is

absorbed form the gastrointestinal tract, it is stored in large quantities in the liver and then

released slowly as needed to the bone marrow. The folic acid also stated in liver

responsible maturation of red blood cells. Even liver can acts as major blood reservoir. It

can store 200 to 400 ml of blood.

Shareera 61

In normal infant and in adult with fibrosis of bone marrow, red blood cells are

produced in the spleen and the liver (Extra medullary hematopoiesis). The red blood cells

normally circulate an average of 120 days before being destroyed. Many of the red cells

fragment in spleen.

The above stated information clearly indicates the important part played by Yakrit

pleeha and amashaya in the development of raktadhatu and also in maintaing its

circulating volume.

Yakrit and pleeha are stated to be the moolas of raktavaha srotas.14 Sushruta

added raktavaha dhamanis.15 Charaka has clearly stated that hridaya (Thoracic heart) and

the ten dhamanees also are to be taken as raktasthana.16 Therefore these also to be

considered as moola of raktavaha srotas.

Since rakta is ashraya for pitta, vitiation of pitta may lead to the vitiation of rakta.

The causes of the disease where in the impairment of both functional and structural

integrity of raktavahasrotas is noticed.

Red blood cell formation [Erythropoiesis]17

Red blood cell formation in adults occurs in the red bone marrow, or myeloid

tissue. Red marrow where active blood cell production occurs is located in portion of

Vertebrae, sternum, ribs, skulls, scapulae, pelvis and proximal limb bones. Other marrow

areas contain a fatty tissue known as yellow marrow.

Stages in RBC Maturation

During its maturation a red blood cell passes through a series of stages

Division of hemocytoblast in bone marrow produce

Shareera 62

1) Myeloid stem cells, which in turn divide to produce red blood cells and several

classes of white blood cells and

2) Lymphoid stem cells, which divides to produce the various classes of

lymphocytes.

The cells destined to become RBCs first differentiate into

Proerythroblasts (Day 1)

Erythroblasts

Basophilic ethroblast (Day 2)

Polychromatophilic ethroblast (Day 3)

Orthochromatophilic ethroblast (Day 4)

Ejection of

Nucleus Reticulocyte (Day 5-7)

Enters the circulation

Mature red blood cell

After roughly 4 days of differentiation, the erythroblast, now called a normoblast,

sheds its nucleus and becomes a reticulocyte. A reticulocyte contains 80 percent of

haemoglobin of matured RBC and hemoglobin synthesis continues for 2-3 days.

After 2 days in the bone marrow, reticulocytes enter the circulation. After 24

hours in circulation, the reticulocyte completes their maturation and becomes

indistinguishable from other mature RBC’s.

Shareera 63

Twak

Vasa and Shat twacha are the upadhatus of mamsa dhatu, which are going to

develop in the process of dhatwagni paka sequential progression of dhatu.18a The twacha

shows the characteristic features of Panduroga as the twacha being affected or showing

the disease significance in the skin (Twacha).

According to the option of Vagbhata embryological development of the skin is

from the blood i.e. Rakta as if from boiling milk cream develops.18b The twacha is having

seven layers. At present disease concern the first two layers can be taken into

consideration.

Avabhasini19

This is outermost and first layer of the skin. If reflects or show the colour of the

second layer lohita. As it reflects the colour it is presumed that the colour change in lohita

is witness in Avabasini. It is being said at the size of 1/18th of vrihi.

Lohita20

Lohita looks like Arunavarna i.e. red in colour and 1/16th of vrihi. It prevents the

blood flow form the body. The colour of the blood in the lohita is reflected through

avabhasini.

Haemoglobin21

Molecules of hemoglobin (Hb) accounts for over 95% percent of the intracellular

proteins, which is specially adopted for gas transport to and from the lungs. It is

composed of four globin chains each containing an iron- containing porphyrin pigment

termed haem. Globin chains are a combination of two alpha and two non-alpha chains.

Shareera 64

The hemoglobin content of whole is reported in terms of grams of Hb per 100 ml

of whole blood (g/dl). Normal range are 14 – 18 g/dl in males and 12-16 g/dl in females.

Each haem units hold an iron in such away that the iron can interact with an

oxygen molecule, forming oxyhemoglobin, HbO2. The iron oxygen molecule interaction

is very weak; the two can easily be separated with out damaging the heme unit or the

oxygen molecule. The binding of an oxygen molecule to the iron in a heme unit is

therefore completely reversible.

Hemoglobin function

There are approximately 280 million Hb molecules in each red blood cell.

Because a Hb molecule contains four heme units, each erythrocyte can potentially carry

more than a billion Molecules of oxygen. Roughly 98.5 percent of oxygen carried by the

blood travels through the circulation bound to Hb molecules inside red blood cells.

The amount of oxygen bound to hemoglobin depends primarily on the oxygen

content of the plasma. When plasma oxygen level are low, hemoglobin releases oxygen

under these conditions, typical of peripheral capillaries, plasma carbon dioxide level are

elevated. The alpha and beta chain of hemoglobin then bind carbon dioxide, forming

“carbaminohemolobin”. In the capillaries of the lungs, plasma oxygen levels are high

and carbon dioxide level are low. Upon reaching these capillaries, RBCs absorb oxygen,

which is then bound to hemoglobin, and release carbon dioxide.

Normal activity levels can be sustained only when tissue oxygen levels are kept

with in normal limit. If hematocrit is low or the hemoglobin content of RBCs is reduced,

the condition of “Anemia” exists. Anemia produces clinical symptoms because it

interferes with oxygen delivery to peripheral tissues. Every system is affected as organ

function deteriorates due to oxygen starvation.

Shareera 65

Functions of Rakta 22

01. Varna prasad – Colour of the skin.

02. Mansapushti – Nourishment to other dhatus like mamsa.

03. Jeevana vyapara – O2 supply.

04. Bala – Strength.

05. Prasannata – Tranquility.

06. Ayu – Life.

According to modern23

♦ The transportation of dissolved gases, nutrients, hormones and metabolic wastes

♦ The regulation of pH and electrolyte composition of intestinal fluid throughout the

body

♦ The restriction of fluid losses trough damaged vessels or at other injury sites.

♦ Defense against toxins and pathogens.

♦ Stabilization of body temperature.

Shuddha Rakta alakshanas24

The following colours indicate pure blood –

01. Shuddha suvarna

02. Indragopa

03. Looks like padma and Alaktaka.

04. Gunjapahala savarnam.

Shuddha rakta purusha lakshanas25

As long as a person is having pure blood in him, he will have;

01. Prasanna sahreera varna.

02. Swasthyata of Indriya and Indriyartha grahana.

03. Prakrita agni.

04. Normal mala, Mutra visarjana.

05. Sukhanuvita.

06. Pushti and Bala.

Shareera 66

Composition of Blood26

Blood is a highly complex fluid, which is composed of two parts - a liquied,

called the plasma and different types of cells that remain suspended in plasma. Thew

cells the called blood corpuscles.

The plasma constitutes about 55%, and cells about 45% of the total volume of the

human blood. General composition of whole blood is as follow.

A. Cells –

1) Red blood corpuscles or erythrocytes (RBC)

2) White blood corpuscles or leucocytes (WBC)

3) Platelets or thrombocytes

B. Plasma –

1) Water 91 to 92%

2) Solids 8-9 %

Inorganic constituents 0.9% (Sodium, Potassium, Calcium, Magnesium,

Phosphorus, Iron, Copper). It contains some organic constituents like –

i. Proteins 7.5% (Serum albumin, Serum globulin Fibrinogen, Prothrombin)

ii. Non-protein Nitrogenous substance [NPN](Urea, Uric acid, Xanthene,

Hypoxanthine, Creatine, Creatinin, Ammonia, amino acids)

iii. Fats (Natural fats, phaspholipid, cholesterol, choletrides)

iv. Carbohydrate (Glucose)

v. Other substances (Internal secretions antibodies and various enzymes)

vi. Colouring matter (The yellow colour of the plasma is due to small amounts of

bilirubin, carotene and xanthophylin).

Shareera 67

DRUG REVIEW

After describing the details regarding various aspects of virechana karma and

Panduroga, it is necessary to go through the details of treatment adopted in the present

study.

The treatment adopted is virechana karma and prior to Virechana karma the

patient is advised for Deepana Pachana depending on the condition (Amaavastha), later

the Snehapana in arohana vidhi is given. Later Abyanga and mridu Swedana is adopted.

For this purpose the following yogas are used.

01. Deepana-pachana – Trikatu churna.1

02. Snehapana – Dadimadi ghrita.2

03. Abhyanga and Swedana – Moorchhita tila taila3 and Ushna jala snana. 4

04. Virechana – Vyoshadi Gutika.5

The drugs used to prepare the above yoga along with the properties are given

below.

Methodology 68

Table No. 19. Properties of ingredients of Trikatu churna. Sl

No.

Sanskrit

Name

Latin

name

Family Rasa Guna Veerya Vipaka Doshaghanata Karma

01. Shunthi6 Zingiber

officinale

Zingiberacease Katu Laghu,

Snigdha

Ushna Madhura Vata and

Kpaha

Agnideepana, Pachana,

Bhedana,

Vatanulomana

02. Maricha7 Piper

nigrum

Piperaceae Katu Ruksha,

Teekshna

Ushna Katu Kapha and

Vata

Deepaka, Pachaka,

Krimighna, Uttejala,

Vatanulomaka

03. Pippali8 Piper

longum

Piperaceae Katu Snigdha,

Lahgu

Anushna Madhura Vata and

Kapha

Deepaka, Pachaka,

Vatanulomana,

Vrishya, Krimighna

Table No. 20. Properties of ingredients of Tila taila. Sl

No. Sanskrit

Name Latin name

Family Rasa Guna Veerya Vipaka Doshaghanata Karma

01. Tila12 Sesamum indicum

Pedaliaceae Katu, Tikta, Madhura, Kashaya

Snigdha, Guru, Grahi

Ushna Katu Pitta and vata

Agnideepana, Pachana, Srotoshodhana, Vatanulomana, Mutrajanana, Balya, Keshya, Vrinaropaka

Table No. 21. Properties of ingredients of Dadima Ghrita. Sl No.

Sanskrit Name

Latin name

Family Rasa Guna Veerya Vipaka Doshaghanata Karma

01. Dadima9 Punica granatum

Puricaceae Madhura, Kashaya

Laghu, Guru, Snighda

Anushna Madhura Tridosha Rochaka, Raktashodhaka, Hridya, Grahi

02. Dhanyaka10 Coriandrum sativum

Umbelliferae Kashaya, Tikta, Katu

Snigdha, Laghu

Ushna Madhura Tridosha Deepaka, Pachaka, Vatanulomaka, Rochaka, Krimighna, Dahashamaka

03. Chitraka11 Plumbago zeylanica

Plumbaginaceae Katu Laghu, Ruksha

Ushna Katu Tridosha Deepaka, Pachaka, Grahi, Uttejaka.

04. Shunthi Zingiber officinale

Zingiberacease Katu Laghu, Snigdha

Ushna Madhura Vata and Kpaha

Agnideepana, Pachana, Bhedana, Vatanulomana

05. Pippali Piper longum

Piperaceae Katu Snigdha, Lahgu

Anushna Madhura Vata & Kapha Deepaka, Pachaka, Vatanulomana, Vrishya, Krimighna

Table No. 22. Properties of ingredients of Vyoshadi Gutika. Sl. No

Sanskrit Name

Latin name Family Rasa Guna Veerya Vipaka Doshaghanata Karma

01. Shunthi Zingiber officinale

Zingiberacease Katu Laghu, Snigdha

Ushna Madhura Vata and Kpaha

Agnideepana, Pachana, Bhedana, Vatanulomana

02. Maricha Piper nigrum Piperaceae Katu Ruksha, Teekshna

Ushna Katu Kapha and Vata

Deepaka, Pachaka, Krimighna, Uttejala, Vatanulomaka

03. Pippali Piper longum Piperaceae Katu Snigdha, Lahgu

Anushna Madhura Vata and Kapha

Deepaka, Pachaka, Vatanulomana, Vrishya, Krimighna

04. Twak13 Cinnamomum zeylanicum

Lauraceae Tikta, Madhura

Laghu, Ruksha, Teekshna

Ushna Katu Vata and Pitta

Deepana, Pachana, Vatanulomana, Uttejaka, Krimighna.

05. Musta14 Cyprus rotendus

Cyperaceae Katu, Tikta, Kashaya

Laghu, Ruksha

Sheeta Katu Kapah and Pitta

Deepana, Pachana, Swedajanaka, Krimighna.

06. Patra15 Cinnamomu tamala

Lauraceae Madhura, Tikta

Alpa Teekshna, Picchila, Laghu

Ushna Katu Kapha and Vata

Deepana, Pachana, Vatanulomana, Uttejaka, Mutrala.

07. Ela16 Elettaric Cardamomum

Zingiberaceae Katu, Madhura

Laghu, Ruksha

Sheeta Madhura Vata Deepana, Pachana, Rochaka, Mutrala, Uttejaka, Krimighna, Raktashodhaka

08. Vidanga17 Emblica ribes Myrsinaceae Katu, Kashaya

Teekshna, Ruksha

Ushna Katu Kapha and vata

Deepana, Pachana, Vatanulomana, Raktashodhaka, Krimighna.

09. Haritaki18 Terminalia chebula

Combretaceae Lavana avrjhit pancharasa

Ruksha, Laghu

Ushna Madhura Tridosha Deepana, Rasayana, Medhya, Anulomaka.

10. Amalaki19 Emblica officinalis

Euphorbiaceae Pancharasa Lavana varjit

Mrudu, Ruksha, Sheeta

Sheeta Madhura Tridosha Deepana, Pachana, Rasayana, Yakrit Uttejaka,

11. Danti20 Baliospermum montanum

Euphorbiaceae Katu Teekshna, Guru

Ushna Katu Kapha and Pitta

Rechaka, Shothaghna, Raktashodhaka

12. Trivirt21 Operculina terpenthelum

_ Madhura, Tikta, Katu

Ruksha, Laghu, Teekshna

Ushna Katu Tridosha Rechaka, Bhedana, Sukhavirechaka

13. Sharkara22 _

_

Madhura Sheetala Madhura Madhura Vata and Pitta

Dahashamaka, Rakta viakraghna, Ruchya, Jwaraghna

14. Madhu23 _

_

Madhura, Kashaya

Laghu, Ruksha, Sukshma, Vishada, Sheeta

_

_

kapha Deepaka, Lekhana, Srotoshadhaka, Varnya, Yogavahi, Rakta shodhaka

Chemical composition of Virechana drugs

01. Pippali – Peper longum. 29

Part Used – Immature berries (i.e. dried unripe fruits or fruiting spikes) dried in

the sun and stem (roots).

Chemical constituent – Resin, volatile oil, starch, gum, fatty oil, inorganic matter

and an alkaloids piperine 1-2 p.c.

Action – Infusion is stimulant, carminative and alternative tonic more powerful

than black pepper, also aphrodisiac, diuretic, vermifuge and emmenagogue. Root is

stimulant.

02. Maricha – Piper negrum. 30

Part used – Dried unripe fruit – Black pepper.

Constituent – A volatile alkaloid piperine 5-9 p.c piperidine 5 p.c. a balsamic

volatile essential oil 1-2 pc fat 7 pc, monsocarp contains chavicin, a balsamic volatile oil,

starch, ligin, gum, fat 1 pc protcids 7 pc and ash containing organic matter 5 pc.

Action – Black pepper is acrid, pungent, hot, carminative also used as

antiperiodic. On the mucous membrane of urethra it acts like cubebs; piperine is mild

antipyretic and antiperiodic.

03. Shunti – Zingiber officinale. 31

Part used – Scraped and dried rhizomes as well as the green ones.

Constituents – Indian ginger contains an aromatic volatile oil 1 to 5 pc of light

yellow colour having a characteristic odour and containing camphene, phellandrene,

zingiberine, cineol and berneol, gingerol a yellow pungent body is an oleoresin

“Gingerin” the active principle, other resins and starch.

Action – Aromatic, carminative, stimulant to the gastrointestinal tract and

stomachic also sialagogue and digestive.

Methodology 73

04. Twak – Cinnamomum zeylanicum. 32

Part used – Dried inner bark of the shoots form trancated stalks (Cinnamomi

cortex) and essential oil (Oleum cinnamomi B.P.)

Constituents – Volatile oil 2 pc Oleum cinnamomum B P is distilled form the

cortex and consists chiefly of cinnamic aldehyde oxidizing into resin and cinnamic acid.

Action – Bark is carminative, antispasmodic, aromatic, stimulant haemostatic,

astringent, antiseptic, stomachic and germicide.

05. Musta – Cyprus rotundus. 33

Part used – Tuber or bulbous root.

Constituents – Fat, sugar, gum, carbohydrates, essential oil, albuminous matter,

starch, fiber and ash. There are traces of an alkaloid.

Action – Stimulant, tonic, demulcent, diuretic, antihelminthis, stomachic,

carminative, diaphoretic, astringent and vermifuge.

06. Patra – Cinnamomum tamala. 34

Part used – Leaves, bark and oil.

Constituents – The leaves contain an essential oil, eugenol, terpene, and cinnamic

aldehydes.

Action – Carminative, stimulant, diuretic, diaphoretic, deobstruent and

lactogogue.

07. Ela – Elettaria cardamomum. 35

Part used – Dried ripe seeds, oil form fruits.

Constituents – Fixed oil, essential oil, volatile oil, volatile oil of the seeds the

active principle 4-8 pc and contains a considerable amount of terpinyl acetate.

Action – Powerful aromatic, stimulant, carminative, stomachic and diuretic.

These properties are due to the essential oil contained in the seeds.

Methodology 74

08. Vidanga – Embelia ribes. 36

Parts used – Berries (fruit), leaves and root bark.

Constituents – Embelic acid a volatile and fixed oil, tannin, christembine.

Action – Carminative, anthelmintic, stimulant and alternative pulp is purgative.

09. Haritaki – Terminalia chebula. 37

Parts used – Dried fruits.

Constituents – Myrobalans cantina astringent principles tannin 45 pc and large

amount of gallic acid.

Action – Myrobalans are a safe and effective purgative astringent and alternative.

10. Amalaki – Emblica officinalis. 38

Part used – Dried fruit.

Constituents – Fruits contain tannin acid, albumin, cellulose, calcium, etc. It

contains Vit. C in large amount. Also contains protein, carbohydrates, red phosphorus,

iron and nicotinic acids.

Action – Fresh fruit is refrigerant, diuretic and laxative. Dried fruit is sour and

astringent.

11. Danti – Baliospermum montanum. 39

Part used – Leaves, seeds and root.

Constituents – Root contains resin and starch.

Action – Seeds are employed as diuretic purgative. Root is purgative.

12. Trivrit – Operculina turpentum. 40

Part used – Root bark.

Constituents – Resin, volatile oil, starch, gum fatty oils, inorganic matter and resin

piperine 1-2%. Also contain resin, albumin, iron, lignanine and some salts.

Action – Root bark contains turpethine, which causes purgation.

Methodology 75

RESEARCH APPROACH

In this work, the aim was to evaluate the efficacy of Virechana karma clinically in

Panduroga.

After completion of treatment including follow up the results were assessed by

comparing subjective the objective parameters taken before and after the treatment.

Source of Data

Patients – Patients suffering form Panduroga were selected incidentally from PG

OPD and IPD of D.G.M.A.M.C., Gadag by pre set inclusion and exclusion criteria.

Literature – Literary aspect of the study was collected from classical Ayurvedic

and modern textbooks and medical magazines.

Therapy – The materials used for virechana therapy were –

01. Trikatu churna.

Sunthi, Maricha, Pippali were taken in equal quantity in the form of fine

powder and mixed well.

02. Dadima Ghrita.

Ingredients of Dadima Ghrita is as below –

Dadima phala twak - 4 Pala.

Dhanyaka - 2 Pala.

Chitraka - 1 Pala.

Shunthi - 1 Pala.

Pippli - 1 Karsha.

Ghrita - 20 Pala.

Jala - 4 Prasta.

Ghrita paka should be done with 20 palas of Ghrita by adding 4 Prasta of Jala and

kalka of above mentioned drugs.

03. Moorchhita tila taila. It was purchaged from local market.

Methodology 76

04. Vyoshadi Gutika.

Ingredients of Vyoshadi Gutika is as below –

01. Pippali

02. Maricha

03. Shunti

04. Twak

05. Musta

06. Patra

07. Ela

08. Vidanga

09. Haritaki

10. Amalaki

All together taken in equal parts – 1 part

11. Danti – 2 parts

12. Trivrit – 8 parts

13. Sharkara – 6 parts

14. Madhu – Avashyanusara

Method of preparation

All the drugs were identified and collected form the local areas. Collected drugs

were prepared for the preparation by removing the physical and chemical impurities. All

the ingredients were made into powder form and mixed well with Madhu thereafter

stored in the form of Avaleha.

Methods

Study design – An observational clinical study.

Sample size – A minimum of 30 patients who were fulfilling the inclusion criteria

were selected for the study and subjected to classical Virechana karma.

Methodology 77

Inclusion criteria

Patients satisfying the following criteria were taken for study they are –

01. Patients of both sexes, between the age of 18-60 years.

02. Patients with classical features of sadya Panduroga and other than that of

exclusion criteria are included.

03. Patients who are fit for virechana therapy.

Exclusion criteria

If any following conditions were noted, such patients were excluded.

01. Patients of age below 18 years and above 60 years.

02. Associated with severe form of systemic disorders like RA, HTN, DM, PT, CA,

etc.

03. The clinical signs and symptoms of Panduroga mentioned in the classics were

initial criteria for the diagnosis. It is further confirmed by the hematological tests.

Intervention

Selected patients were given Virechana karma.

A. Deepana-Pachana – The patients were administered Trikatu churna 3-6 gm

thrice daily before food, till the appearance of Nirama laskhanas.

B. Snehapana – After the appearance of nirama lakshanas the patients were

administered snehapana with Dadima Ghrita in arohanavidhi. The snehapana was

started with hrasayasi matra i.e. 30 ml and gradually increased for 3-4 days. For

Panduroga “Na atisnigdhaan Virechayet” has been mentioned in the classics.

C. Abhyanga & Mridu Swedana – As swedana is contraindicated in Panduroga, the

patients were administered abhyanga with moorchhita tila taila followed by Mridu

swedana (ushna jala snana).

Methodology 78

D. Virechana karma – On the fourth day the patients were given with Virechana

yoga after assessing the Koshta, Agni and Bala of the patient. The medicine used

was “Vyoshadi Gutika”

Matra – 35-45 gms

Anupana – Sheetajala.

E. Samsarjana krama – Samsarjana krama is followed for three to five days

depending on the type of shuddhi achieved.

F. Follow up – Follow up was advised for 15 days. During this period patient was

advised to follow the pathyapathya mentioned in the context of Panduroga.

G. Result assessment criteria – The following subjective and objective parameters

were considered for the result assessment.

Subjective parameters

The following lakshanas were taken into consideration for assessing the patient –

01. Panduta

02. Arohanayasa

03. Dourbalya

04. Bhrama

05. Agnimandya

Objective Parameters

The following investigations were done prior and after the study.

01. Haemoglobin estimation (Hb).

02. Total RBC count.

03. Packed cell volume (PCV)

04. Mean corpuscular volume (MCV)

05. Mean corpuscular haemoglobin concentration (MCHC)

06. Peripheral blood smear examination.

Methodology 79

Investigation & their normal values

01. Hb – Male – 14.0 g/dl to 17.4 g/dl.

- Female 12.3 g/dl to 15.3g/dl.

02. PCV – Male – 40-54% Average – 46%-41%.

- Female 37-47%.

03. RBC count – Male – 5.5+4x1012/L.

- Female 4.8+1.0x1012/l.

04. MCV – 77-93 cum Average 90 cum.

05. MCHC – 30-35% Average 33.3%.

Score chart

A. Panduta (Pallor)

01. Absent (No pallor) – 0

02. Mild – 1

03. Moderate – 2

04. Severe – 3

B. Arohanayasa (Exertional Dyspnoea)

01. No exertional dyspnoea – 0

02. Mild dyspnoea – 1

03. Dyspnoea distrupts patients daily activities intermittently – 2

04. Dyspnoea distrupts daily activities frequently – 3

C. Bhrama

01. Absent – 0

02. Occasional – 1

03. Frequently – 2

04. Regular – 3

05. Constant – 4

Methodology 80

F. Agnimandya

01. Present before the treatment – 2

02. Improvement – 1

03. Absent – 0

Overall assessment

The overall results were declared only the basis of Haemoglobin and

improvement in clinical symptoms is also considered. Following method of overall

grading was used.

01. Good response – Patients with 60% and above results, by considering 0.1 gm

improvement in haemoglin as 4%.

02. Moderate response – Patients with 30% to 59% results by considering 0.1 gm

improvement in haemoglin as 4%.

03. Poor response – Patients with 1% to 29% of results, by considering 0.1 gm

improvement in haemoglin as 4%.

04. No response – Patients with no change after treatment.

Statistical Analysis

The information gathered on the basis of observation made on the subjective and

objective parameters taken before the treatment, after the virechana and after the follow

up was subjected to statistical analysis. As this is an observational study, paired “t” test

was used.

Methodology 81

In this clinical study, totally 42 cases were reported. Among them 38 cases were

came under the study, 8 patients were discontinued, so 30 patients were completed the

total study duration. Selected patients were subjected to classical Virechana therapy and

assessment was done by considering both subjective and objective parameters. The

changes were recorded according to the prorforma of the case sheet.

Table No. 23. Showing the status of patients of the present study.

Sl. Total cases Registered No. of Pt.’s came under study Discontinued Completed

01. 42 38 8 30

The data collected was as follows –

01. Demographic data.

02. Data related to disease.

03. Data related to treatment.

04. Data related to parameters.

DEMOGRAPHIC DATA

Distribution of patients age groups.

Table No. 24. Showing the age wise distribution and response of the patients.

Sl. Age

Gr.

No. of Pt. % G.R. % M.R. % P.R. %

01. 18-24 14 46.66 2 14.28 8 57.14 4 28.57

02. 24-30 4 13.33 2 50 2 50 0 0

03. 30-36 4 13.33 3 75 1 25 0 0

04. 36-42 5 16.66 1 20 3 60 1 20

05. 42-48 0 0 0 0 0 0 0 0

06. 48-54 2 6.66 1 50 1 50 0 0

07. 54-60 1 3.33 1 100 0 0 0 0

Observations & Results 82

Age group of 18-24 contains 14 patients (46%), among them 2 patients (14.28%)

responded good, 8 patients (57.14%) were moderately responded and 4 patients (28.57%)

had shown poor response.

Age group of 24-30 contains 4 patients (46.66%), among them 2 patients (50%)

responded good, 2 patients (50%) were moderately responded.

Age group of 30-36 contains 4 patients (13.33%), among them 3 patients (75%)

responded good, 1 patient (25%) was moderately responded.

Age group of 36-42 contains 5 patients (16.66%), among them 1 patient (20%)

responded good, 3 patients (60%) were moderately responded and 1 patient (20%) had

shown poor response.

Age group of 48-54 contains 2 patients (6.66%), among them 1 patient (50%)

responded good, 1 patient (50%) was moderately responded.

Age group of 54-60 contains 1 patient (3.33%), among them 1 patient (100%)

responded good.

Graph No. 01. Showing the distribution of patients by age groups and response.

Distribution of Pt.'s by Age Groups

14

4 4 5

02 12 2 3

1 0 1 1

8

2 13

0 1 0

4

0 0 1 0 0 002468

10121416

18-24 24-30 30-36 36-42 42-48 48-54 54-60

Age groups

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 83

Distribution of patients by Sex.

Table No. 25. Showing the Sex distribution and response of the patients.

Sl. Sex No. of Pt. % G.R. % M.R. % P.R. %

01. Male 8 26.66 2 25 4 50 2 25

02. Female 22 73.33 7 31.81 11 50 4 18.18

Out of 30 patients 22 patients (73.33%) were female, in which 7 patients

(31.81%) shown good response, 11 patients (50%) shown moderate response and 4

patients (18.18%) had shown poor response.

Remaining 8 patients (26.66%) were male, in which 2 patients (25%) shown good

response, 4 patients (50%) shown moderate response and 2 patients (25%) had shown

poor response.

Graph No. 02. Distribution of patients by sex and response.

Distribution of patients by Sex

8

22

2

7

4

11

24

0

5

10

15

20

25

Male Female

Sex

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 84

Observations & Results 85

Distribution of patients by religion.

Table No. 26. Showing the religion distribution and response of the patients.

Sl. Religion No. of Pt. % G.R. % M.R. % P.R. %

01. Hindu 25 83.33 8 32 11 44 6 24

02. Muslim 5 16.66 1 20 4 80 0 0

03. Christian 0 0 0 0 0 0 0 0

04. Others 0 0 0 0 0 0 0 0

Out of 30 patients, 25 patients (83.33%) were belonging to Hindu community, in

which 8 patients (32%) shown good response, 11 patients (44%) responded moderately

and 6 patients (24%) had shown poor response.

Remaining 5 patients (16.66%) were belonging to Muslim community, in which 1

patient (20%) shown good response, 4 patients (80%) responded moderately.

Graph No. 03. Showing distribution of patients by religion and response.

Distribution of Pt.'s by Religion

25

5

0 0

8

1 0 0

11

4

0 0

6

0 00

5

10

15

20

25

30

Hindu Muslim Christian Others

Response

No.

of P

t.'s

0

No. of Pt. G.R. M.R. P.R.

Distribution of patients by Occupation.

Table No. 27. Showing the occupation distribution and response of the patients.

Sl. Occupation No. of Pt. % G.R. % M.R. % P.R. %

01. Household 7 23.33 2 28.57 4 57.14 1 14.2

02. Study 11 36.66 1 9.0 6 54.54 4 36.36

03. Service 3 10 1 33.33 2 66.66 0 0

04. Labour 3 10 0 0 2 66.66 1 33.33

05. Sedentary 6 20 5 83.33 1 16.66 0 0

Among 30 patients 7 patients (23.33%) were household, in which 2 patients

(28.57%) shown good response, 4 patients (57.14%) were moderately responded and 1

patient (14.2%) had shown poor response.

11 patients (36.66%) were students, in which 1 patient (9%) shown good

response, 6 patients (54.54%) were moderately responded and 4 patients (36.36%) had

shown poor response.

3 patients (10%) were in service, in which 1 patient (33.33%) shown good

response, 2 patients (66.66%) were moderately responded.

3 patients (10%) were labours, in which 2 patients (66.66%) were moderately

responded and 1 patient (33.33%) had shown poor response.

6 patients (20%) were in sedentary occupational group, in which 5 patients

(83.33%) shown good response, 1 patient (16.66%) was moderately responded.

Graph No. 04. Showing the distribution of patients by occupation and response.

Distribution of Pt.'s by Occupation

7

11

3 3

6

21 1

0

54

6

2 211

4

01

00

2

4

6

8

10

12

HH St Sr Lb Sed

Occupation

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 86

Distribution of patients by Socioeconomic status.

Table No. 28. Showing the Socioeconomic status distribution and response of the

patients.

Sl. Socioeconomic

status

No. of

Pt.

% G.R. % M.R. % P.R. %

01. Poor 5 16.16 1 20 3 60 1 20

02. Middle class 16 53.33 7 43.75 5 31.25 4 25

03. Upper middle class 9 30 2 22.22 6 66.66 1 11.11

Among 30 patients 5 patients (16.16%) were in poor socio-economical group, in

which 1 patient (20%) shown good response, 3 patients (60%) were moderately

responded and 1 patient (20%) had shown poor response.

16 patients (53.33%) were in middle class socio-economical group, in which 7

patient (43.75%) shown good response, 5 patients (31.25%) were moderately responded

and 4 patients (25%) had shown poor response.

9 patients (30%) were in upper middle class socio-economical group, in which 2

patient (22.22%) shown good response, 6 patients (66.66%) were moderately responded

and 1 patient (11.11%) had shown poor response.

Graph No. 05. Showing the distribution of patients by socio-economical status and

response. Distribution of Pt.'s by Socio-economical status

5

16

9

1

7

235 6

14

102468

1012141618

PC MC UMC

Socio-economical Status

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 87

Distribution of patients by Marital status.

Table No. 29. Showing the marital status distribution and response of the patients.

Sl. Marital status No. of Pt. % G.R. % M.R. % P.R. %

01. Married 20 66.66 7 35 10 50 3 15

02. Unmarried 10 33.33 2 20 5 50 3 30

Among 30 patients 20 patients (66.66%) were married, in which 7 patients (35%)

shown good response, 10 patients (50%) were moderately responded and 3 patients

(15%) had shown poor response.

10 patients (33.33%) were unmarried, in which 2 patients (20%) shown good

response, 5 patients (50%) were moderately responded and 3 patients (30%) had shown

poor response.

Graph No. 06. Showing the distribution of patients by marital status and response.

Distribution of Pt.'s by Marietal status

20

107

2

10

53 3

0

5

10

15

20

25

Married Unmarried

Marietal status

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 88

Distribution of patients in food habits.

Table No. 30. Showing the food habits distribution and response of the patients.

Sl. Food habits No. of Pt. % G.R. % M.R. % P.R. %

01. Vegetarian 21 70 6 28.57 10 47.61 5 23.80

02. Mixed 9 30 2 22.22 6 66.66 1 11.11

Among 30 patients 21 patients (70%) were vegetarian, in which 6 patients

(28.57%) shown good response, 10 patients (47.61%) were moderately responded and 5

patients (23.80%) had shown poor response.

9 patients (30%) were mixed type of food habit, in which 2 patients (22.22%)

shown good response, 6 patients (66.66%) were moderately responded and 1 patient

(11.11%) had shown poor response.

Graph No. 07. Showing the distribution of patients by food habits and response.

Distribution of Pt.'s by Food habits

21

96

2

10

65

10

5

10

15

20

25

Vegetarian Mixed

Food habits

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 89

Distribution of patients in treatment history.

Table No. 31. Showing the distribution of patient’s treatment history and response.

Sl. Treatment history No. of Pt. % G.R. % M.R. % P.R. %

01. Modern 15 50 6 40 6 40 3 20

02. Ayurvedic 2 6.66 1 50 1 50 0 0

03. Surgery 1 3.33 1 100 0 0 0 0

04. No History 13 43.33 2 1538 9 69.23 2 15.38

Among 30 patients 15 patients (50%) underwent modern treatment, in which 6

patients (40%) shown good response, 6 patients (40%) were moderately responded and 3

patients (20%) had shown poor response.

2 patients (6.66%) underwent Ayurvedic treatment, in which 1 patient (50%)

shown good response, 1 patient (50%) was moderately responded.

Graph No. 08. Showing the distribution of patients by treatment history and response.

Distribution of Pt.'s by Treatment History

15

21

13

6

1 12

6

10

9

3

0 0

2

02468

10121416

Md Ar Sr No

Treatment History

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 90

Distribution of patients by Prakriti.

Table No. 32. Showing the distribution of patient deha prakriti and response.

Sl. Prakriti No. of Pt. % G.R. % M.R. % P.R. %

01. Vata pitta 8 26.66 2 25 5 62.5 1 12.5

02. Vata shelshma 6 20 1 16.66 2 33.33 3 50

03. Pitta kapha 16 53.33 6 37.5 7 43.75 3 18.75

Among 30 patients 8 patients (26.66%) were of Vata-pittaja prakriti, in which 2

patients (25%) shown good response, 5 patients (62.5%) were moderately responded and

1 patient (12.5%) had shown poor response.

6 patients (20%) were of Vata-shelshmaja prakriti, in which 1 patient (16.66%)

shown good response, 2 patients (33.33%) were moderately responded and 3 patients

(50%) had shown poor response.

16 patients (53.33%) were of Pitta-shleshmaja prakriti, in which 6 patients

(37.5%) shown good response, 7 patients (43.75%) were moderately responded and 3

patients (18.75%) had shown poor response.

Graph No. 09. Showing the distribution of patients by deha prakriti and response.

Distribution of Pt.'s by Dehaprakriti

86

16

2 1

65

2

7

13 3

02468

1012141618

VP VS PK

Deha Prakriti

No.

of P

t.s'

No. of Pt. G.R. M.R. P.R.

Observations & Results 91

Distribution of patients by Vyasana.

Table No. 33. Showing the distribution of patient by Vyasana and response.

Sl. Vyasana No. of Pt. % G.R. % M.R. % P.R. %

01. Smoking 4 13.33 1 25 2 50 1 25

02. Alcohol 1 3.33 0 0 1 100 0 0

03. Tobacco 6 20 2 33.33 2 33.33 2 33.33

04. No Habits 21 70 6 28.57 11 52.38 4 19.05

Among 30 patients, 4 patients (13.33%) were habituated to smoking, in which 1

patient (25%) shown good response, 2 patients (50%) were moderately responded and 1

patient (25%) had shown poor response.

1 patient (3.33%) was habituated to alcohol, which was shown moderately

responded.

6 patients (20%) were habituated to tobacco, in which 2 patients (33.33%) shown

good response, 2 patients (33.33%) were moderately responded and 2 patients (33.33%)

had shown poor response.

21 patients (70%) were not addicted to habits, in which 6 patients (28.57%)

shown good response, 11 patients (52.38%) were moderately responded and 4 patients

(19.05%) had shown poor response.

Graph No. 10. Showing the distribution of patients by vyasana and response.

Distribution of Pt.'s by Vyasana

41

6

21

1 02

6

2 1 2

11

1 02

4

0

5

10

15

20

25

Sm Alc Tb NoHabits

No

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 92

Distribution of patients by Koshta.

Table No. 34. Showing the distribution of patient Koshta and response.

Sl. Koshta No. of Pt. % G.R. % M.R. % P.R. %

01. Mridu 2 6.66 0 0 2 100 0 0

02. Madhyama 22 73.33 8 36.36 11 50 3 13.63

03. Krura 6 20 1 16.66 2 33.33 3 50

Among 30 patients, 2 patients (6.66%) were of Mridu koshta and responded

moderately.

22 patients (73.33%) were of Madhyama koshta, in which 8 patients (36.36%)

shown good response, 11 patients (50%) were moderately responded and 3 patients

(13.63%) had shown poor response.

6 patients (20%) were of Krura koshta, in which 1 patient (16.66%) shown good

response, 2 patients (33.33%) were moderately responded and 3 patients (50%) had

shown poor response.

Graph No. 11. Showing the distribution of patients by nature of Koshta and response.

Distribution of Pt.'s by Nature of Koshta

2

22

6

0

8

12

11

20

3 3

0

5

10

15

20

25

Mridu Madhyama Krura

Nature of Koshta

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 93

Distribution of patients by Agni.

Table No. 35. Showing the distribution of patient by Agni and response.

Sl. Agni No. of Pt. % G.R. % M.R. % P.R. %

01. Manda 22 73.33 8 36.36 11 50 3 13.63

02. Vishama 3 10 1 33.33 2 66.66 0 0

03. Sama 5 16.66 0 0 3 60 2 40

Among 30 patients, 22 patients (73.33%) were having Mandagni, in which 8

patients (36.36%) shown good response, 11 patients (50%) were moderately responded

and 3 patients (13.63%) had shown poor response.

3 patients (10%) were having Vishamagni, in which 1 patient (33.33%) shown

good response, 2 patients (66.66%) were moderately responded.

5 patients (16.66%) were having Samagni, in which 3 patients (60%) moderately

responded and 2 patients (40%) had shown poor response.

Graph No. 12. Showing the distribution of patients by nature of agni and response.

Distribution of Pt.'s by Nature of Agni

22

35

8

1 0

11

2 330

2

0

5

10

15

20

25

Manda Vishama Sama

Nature of Agni

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 94

DATA RELATED TO DISEASE

Distribution of patients by Nidanas and response.

Table No. 36. Showing the distribution of patient by Nidana and response.

Sl. Nidana No. of Pt. % G.R. % M.R. % P.R. %

Aharaja Nidana

01. Kshara 26 86.66 7 26.92 15 57.69 4 15.38

02. Amla 28 93.33 9 32.14 15 5357 4 14.28

03. Lavana 20 66.66 6 30 13 65 1 5

04. Atiushna 20 66.66 5 25 13 65 2 20

05. Ati tikshna 26 86.66 7 26.92 15 57.69 4 15.38

06. Virudhha 19 63.33 6 31.58 13 68.42 0 0

07. Tila 15 50 3 20 11 73.33 1 6.66

08. Masha 22 73.33 4 18.18 15 68.18 3 13.63

09. Mrit 0 0 0 0 0 0 0 0

Viaharaja Nidanas

10. Divaswapna 22 86.66 4 18.18 15 68.18 3 13.63

11. Ativyayama 20 66.66 6 30 13 65 1 15

12. Ratri jagarana 19 63.33 5 26.31 12 63.15 2 10.52

13. Vegadharana 5 16.66 2 40 2 40 1 20

14. Atapa sevana 14 46.66 4 28.57 9 64.28 1 7.14

Manasika Nidanas

15. Chinta 20 66.66 4 20 14 70 2 10

16. Krodha 28 93.33 7 25 15 53.57 6 21.42

17. Shoka 15 50 5 33.33 10 66.66 0 0

18. Bhaya 10 33.33 3 30 5 15 2 20

Aharaja Nidana

Out of 30 patients, 26 patients (86.66%) were indulging in excess use of kshara

type of foods, in which 7 patients (26.92%) were responded good, 15 patients (57.69%)

were moderately responded, 4 patients (15.38%) had shown poor response.

Observations & Results 95

28 patients (93.33%) were indulging in excess use of Amla type of foods, in

which 9 patients (32.14%) were responded good, 15 patients (53.57%) were moderately

responded, 4 patients (14.28%) had shown poor response.

20 patients (66.66%) were indulging in excess use of lavana type of foods, in

which 6 patients (30%) were responded good, 13 patients (65%) were moderately

responded, 1 patient (5%) had shown poor response.

20 patients (66.66%) were indulging in excess use of ushna type of foods, in

which 5 patients (25%) were responded good, 13 patients (65%) were moderately

responded, 2 patients (10%) had shown poor response.

26 patients (86.66%) were indulging in excess use of teekshna type of foods, in

which 7 patients (26.92%) were responded good, 15 patients (57.69%) were moderately

responded, 4 patients (15.38%) had shown poor response.

19 patients (63.66%) were indulging in excess use of viruddha type of foods, in

which 6 patients (31.58%) were responded good, 13 patients (68.42%) were moderately

responded, 1 patient (6.66%) had shown poor response.

15 patients (50%) were indulging in excess use of tila in foods, in which 3

patients (20%) were responded good, 11 patients (73.33%) were moderately responded, 4

patients (15.38%) had shown poor response.

22 patients (73.33%) were indulging in excess use of masha in foods, in which 4

patients (18.18%) were responded good, 15 patients (68.18%) were moderately

responded, 3 patients (13.63%) had shown poor response.

Graph No. 13. Showing the distribution of Pt.’s by Aharaja Nidana and response.

Distribution of Pt.'s by Aharaj Nidana sevana wit response

2628

20 20

26

1915

22

0

79

6 57 6

3 40

15 1513 13

1513

1115

04 4

1 24

0 13

00

5

10

15

20

25

30

A B C D E F G H I

Aharaj Nidana

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 96

Viharaja Nidana

Out of 30 patients, 22 patients (86.66%) were indulging in excess of divaswapna,

in which 4 patients (18.18%) were responded good, 15 patients (68.18%) were

moderately responded, 3 patients (13.63%) had shown poor response.

20 patients (66.66%) were indulging in ativyayama, in which 6 patients (30%)

were responded good, 13 patients (65%) were moderately responded, 1 patient (5%) had

shown poor response.

19 patients (63.33%) were indulging in ratrijagarana, in which 5 patients

(26.39%) were responded good, 12 patients (63.15%) were moderately responded, 2

patients (10.52%) had shown poor response.

5 patients (16.66%) were indulging in vegadharana, in which 2 patients (40%)

were responded good, 2 patients (40%) were moderately responded, 1 patient (20%) had

shown poor response.

14 patients (46.66%) were indulging in atapa sevana, in which 4 patients

(28.57%) were responded good, 9 patients (64.28%) were moderately responded, 1

patient (7.14%) had shown poor response.

Graph No. 14. Showing the distribution of pt.’s by Viharaj Nidana and response.

Distribution of Pt.'s by Viharaja Nidana and response

2220 19

5

14

46 5

24

1513 12

2

9

31 2 1 1

0

5

10

15

20

25

J K L M N

Viharaj Nidana

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 97

Manasika Nidana

Out of 30 patients, 20 patients (66.66%) were indulging in excess chinta, in which

4 patients (20%) were responded good, 14 patients (70%) were moderately responded, 2

patients (10%) had shown poor response.

28 patients (93.33%) were indulging in excess krodha, in which 7 patients (25%)

were responded good, 15 patients (53.57%) were moderately responded, 6 patients

(21.42%) had shown poor response.

15 patients (50%) were indulging in excess shoka, in which 5 patients (33.33%)

were responded good, 10 patients (66.66%) were moderately responded.

10 patients (33.33%) were indulging in excess bhaya, in which 3 patients (30%)

were responded good, 5 patients (50%) were moderately responded, 2 patients (20%) had

shown poor response.

Graph No. 15. Showing the distribution of patients by Mansika Nidana and response.

Distribution of Pt.'s by Manasika Nidana & Response

20

28

15

10

47

53

14 15

10

52

6

02

0

5

10

15

20

25

30

O L M NManasika Nidana

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 98

Data related to incidence of lakshanas and response.

Table No. 37. Distribution of the patients according to incidence of lakshanas and

response.

Sl. Lakshanas No. of Pt. % G.R. % M.R. % P.R. %

01. Panduta 30 100 9 30 15 50 6 20

02. Arohana Ayasa 24 80 8 33.33 13 54.16 3 12.5

03. Dourbalya 29 96.66 9 31.03 14 48.27 6 20.68

04. Bhrama 29 96.66 9 31.03 14 48.27 6 20.68

05. Agnimanndya 20 83.33 9 36 11 44 5 20

Out of 30 patients, all were represented Panduta, in which 9 patients (30%) were

responded good, 15 patients (50%) were moderately responded, 6 patients (20%) had

shown poor response.

24 patients (80%) were having arohana ayasa, in which 8 patients (33.33%) were

responded good, 13 patients (54.16%) were moderately responded, 3 patients (12.50%)

had shown poor response.

29 patients (96.66%) were having dourbalya and bhrama, in which 9 patients

(31.03%) were responded good, 14 patients (48.27%) were moderately responded, 6

patients (20.68%) had shown poor response.

25 patients (83.33%) were having agnimandya, in which 9 patients (36%) were

responded good, 11 patients (44%) were moderately responded, 5 patients (20%) had

shown poor response.

Graph No. 16. Showing the distribution of patients by incidence of lakshnas and

response. Distribution of Pt.'s by Lakshanas & Response

3024

29 29

20

9 8 9 9 915 13 14 14

116

36 6 5

05

101520253035

Pd AA Dl Br AmLakshanas

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 99

Distribution of the patients by type of Panduroga and response.

Table No. 38. Showing the types of pandu roga and response.

Sl. Types of Pandu No. of Pt. % G.R. % M.R. % P.R. %

01. Vataja 6 20 1 16.66 3 50 2 33.33

02. Pittaja 14 46.66 6 42.85 7 50 1 7.14

03. Kaphaja 10 33.33 2 20 6 60 2 20

Out of 30 patients, 6 patients (20%) were of Vataja Pandu, in which 1 patient

(16.66%) were responded good, 3 patients (50%) were moderately responded, 2 patients

(33.33%) had shown poor response.

14 patients (46.66%) were of Pittaja Pandu, in which 6 patients (42.85%) were

responded good, 7 patients (50%) were moderately responded, 1 patient (7.14%) had

shown poor response.

10 patients (33.33%) were of Kaphaja Pandu, in which 2 patients (20%) were

responded good, 6 patients (60%) were moderately responded, 2 patients (20%) had

shown poor response.

Graph No. 17. Showing the distribution of patients by type of Panduroga and treatment.

Distribution of Pt.'s by types of type of Pandu & Response

6

14

10

1

6

23

7 6

2 1 2

0

5

10

15

Vataj Pittaj Kaphaj

Type of Pandu

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 100

DATA RELATED TO TREATMENT

Distribution of patients according to snehapana kalavadhi and response.

Table No. 39. Showing the distribution of patient by snehapana kalavadhi and response.

Sl. Snehapana kalavadhi No. of Pt. % G.R. % M.R. % P.R. %

01. Up to 3 days 20 66.66 4 20 12 60 4 20

02. More than 3 days 10 33.33 5 50 3 30 2 20

Out of 30 patients, 20 patients (66.66%) were received snehapana for 3 days, in

which 4 patients (20%) were responded good, 12 patients (60%) were moderately

responded, 4 patients (20%) had shown poor response.

10 patients (33.33%) were received snehapana more than 3 days, in which 5

patients (50%) were responded good, 3 patients (30%) were moderately responded, 2

patients (20%) had shown poor response.

Graph No. 18. Showing the distribution of patients by the snehapana kalavadhi and

response.

Distribution of Pt.'s by duration of snehanapana & Response

20

10

4 5

12

34 205

10152025

Up to 3 days More than 3 days

Duration of Snehapana

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 101

Distribution of patients according to samyak snigdha lakshana and response.

Table No. 40. Showing the distribution of patient by samyak snigdha lakshana and

response.

Sl. Samyak snigdha

lakshana

No. of

Pt.

% G.R. % M.R. % P.R. %

01. Vatanulomana 27 90 9 33.33 15 55.55 3 11.11

02. Agnideepti 30 100 9 30 15 50 6 20

03. Purisha snigdhata 30 100 9 30 15 50 6 20

04. Asamhata varchas 26 86.66 8 30.76 14 53.84 4 15.38

05. Twak snigdhata 28 93.33 9 32.14 15 57.69 4 14.28

06. Anga laghava 24 80 8 33.33 15 62.5 1 3.57

07. Gatra mardava 24 80 8 33.33 15 62.5 1 3.57

08. Snehodwega 20 66.66 9 45 11 55 0 0

09. Klama 26 86.66 9 34.61 15 57.69 2 7.69

10. Shiathilya 12 40 6 50 5 41.66 1 8.33

Out of 30 patients, 27 patients (90%) were reported Vatanulomana, in which 9

patients (33.33%) were responded good, 15 patients (55.55%) were moderately

responded, 3 patients (11.11%) had shown poor response.

All patients were reported Agnideepti and Purisha snigdhata, in which 9 patients

(30%) were responded good, 15 patients (50%) were moderately responded, 6 patients

(20%) had shown poor response.

26 patients (86.66%) were reported Asamhata varchasa, in which 8 patients

(30.76%) were responded good, 14 patients (53.84%) were moderately responded, 4

patients (15.38%) had shown poor response.

28 patients (93.33%) were reported Twak snigdhata, in which 9 patients (32.14%)

were responded good, 15 patients (57.69%) were moderately responded, 4 patients

(14.28%) had shown poor response.

Observations & Results 102

24 patients (80%) were reported Angalaghava and Gatramardavata, in which 8

patients (33.33%) were responded good, 15 patients (62.50%) were moderately

responded, 1 patient (3.57%) had shown poor response.

20 patients (66.66%) were reported Snehodwega, in which 9 patients (45%) were

responded good, 11 patients (55%) were moderately responded.

26 patients (86.66%) were reported Klama, in which 9 patients (34.61%) were

responded good, 15 patients (57.69%) were moderately responded, 2 patients (7.69%)

had shown poor response.

12 patients (40%) were reported Shaithilya, in which 6 patients (50%) were

responded good, 5 patients (41.66%) were moderately responded, 1 patient (8.33%) had

shown poor response.

Graph No. 19. Showing the distribution of patients by appearance of Samyak snigdha

lakshanas and response.

Distribution of Pt.'s by appearance of Samyak snigdha Lakshana & Response

2730 30

2628

24 2420

26

129 9 9 8 9 8 8 9 9

6

15 15 15 14 15 15 1511

15

53

6 64 4

1 1 02 1

0

5

10

15

20

25

30

35

A B C D E F G H I J

Samyak Snigdha Lakshna

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 103

Distribution of patients according to Vegas attended and response.

Table No. 41. Showing the distribution of patient by Vega attended and response.

Sl. Vegiki No. of Pt. % G.R. % M.R. % P.R. %

01. Below 10 7 23.33 2 28.57 4 57.14 1 14.28

02. 10-20 19 63.33 7 36.84 8 42.10 4 21.05

03. Above 20 4 13.33 0 0 3 75 1 25

Out of 30 patients, 7 patients (23.33%) attained less than 10 vegas, in which 2

patients (28.57%) were responded good, 4 patients (57.14%) were moderately responded,

1 patient (14.28%) had shown poor response.

19 patients (63.33%) attained in between 10-20 vegas, in which 7 patients

(36.84%) were responded good, 8 patients (42.10%) were moderately responded, 4

patients (21.05%) had shown poor response.

4 patients (13.33%) attained more than 20 vegas, in which 3 patients (75%) were

moderately responded, 1 patient (25%) had shown poor response.

Graph No. 20. Showing the distribution of the patients by Vegiki and response.

Distribution of Pts.'s by Vegiki & Response

7

19

42

7

0

4

8

31

4

102468

101214161820

Below 10 10 to 20 Above 20

No. of Vegas attainded

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 104

Distribution of patients according to Maniki and response.

Table No. 42. Showing the distribution of patient by Maniki and response.

Sl. Maniki No. of Pt. % G.R. % M.R. % P.R. %

01. 2000 ml and above 14 46.66 2 14.28 10 71.42 4 28.57

02. Less than 2000 16 53.33 7 43.75 5 31.25 2 12.5

Out of 30 patients, 14 patients (46.66%) possessed 2000 ml and above mala, in

which 2 patients (14.28%) were responded good, 10 patients (71.42%) were moderately

responded, 4 patients (28.57%) had shown poor response.

16 patients (53.33%) possessed less than 2000 ml of mala, in which 7 patients

(43.75%) were responded good, 5 patients (31.25%) were moderately responded, 2

patient (12.50%) had shown poor response.

Graph No. 21. Showing the distribution of patients by Maniki and response.

Distribution of Pt.'s by Maniki & Respnse

1416

2

7

10

542

02468

1012141618

2000 ml and above Less than 2000

Vega attainded

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 105

Distribution of patients according to Antaki and response.

Table No. 43. Showing the distribution of patient by Antaki by the patient and response.

Sl. Anataki No. of Pt. % G.R. % M.R. % P.R. %

01. Kaphantam is observed 30 100 9 30 15 50 6 20

02. Kaphantam is not observed 0 0 0 0 0 0 0 0

Kaphantam Virechana was observed in all patients, in which 9 patients (30%)

were responded good, 15 patients (50%) were moderately responded, 6 patients (20%)

had shown poor response.

Graph No. 22. Showing the distribution of Patients by Antiki and response.

Distribution of Pt.'s by Antaki with Response

30

0

9

0

15

06

005

101520253035

Kaphantam is observed Kaphantam is not observed

Antaki Lakshana

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Distribution of patients according to Laingiki shuddhi obtained and response.

Table No. 44. Showing the distribution of patient by Laingiki shuddhi obtained and

response.

Sl. Laingiki shuddhi No. of Pt. % G.R. % M.R. % P.R. %

01. Srotoshuddhi 28 93.33 9 32.14 16 57.14 3 10.71

02. Indriya prasadana 25 83.33 8 32 15 60 2 8

03. Shareera lahuta 26 86.66 6 23.07 16 61.53 4 15.38

04. Agni deepti 29 96.66 9 31.03 15 51.72 5 17.24

05. Vatanulomana 27 90 9 33.33 15 55.55 3 11.11

Observations & Results 106

Out of 30 patients, 28 patients (93.33%) were having Srotoshuddhi, in which 8

patients (32%) were responded good, 16 patients (57.14%) were moderately responded, 3

patients (10.71%) had shown poor response.

25 patients (83.33%) were having Indriya prasadana, in which 8 patients (32.14%)

were responded good, 15 patients (60%) were moderately responded, 2 patients (8%) had

shown poor response.

26 patients (86.66%) were having Sahreera laghuta, in which 6 patients (23.07%)

were responded good, 16 patients (61.53%) were moderately responded, 4 patients

(15.38%) had shown poor response.

29 patients (96.66%) were having Agnideepti, in which 9 patients (31.03%) were

responded good, 15 patients (51.72%) were moderately responded, 5 patients (17.24%)

had shown poor response.

27 patients (90%) were having Anamayata, in which 8 patients (29.62%) were

responded good, 15 patients (55.55%) were moderately responded, 4 patients (14.81%)

had shown poor response.

27 patients (90%) were having Vatanuloamana, in which 9 patients (33.33%)

were responded good, 15 patients (55.55%) were moderately responded, 3 patients

(11.11%) had shown poor response.

Graph No. 23. Showing the distribution of patients by laingiki shuddhi and response.

Distribution of Pt.'s by Laingiki shuddhi & Response

2825 26

29 27

9 8 69 9

16 15 16 15 15

3 2 4 5 3

05

101520253035

SS IP SL AD AL

Laingiki Shuddhi Lakshanas

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 107

Distribution of patients according to type of shuddhi and response.

Table No. 45. Showing the distribution of patient type of shuddhi and response.

Sl. Type of Shuddhi No. of Pt. % G.R. % M.R. % P.R. %

01. Pravara 7 23.33 2 28.57 4 57.17 1 14.28

02. Madhyama 19 63.33 7 36.84 8 42.10 4 21.05

03. Avara 4 13.33 0 0 3 75 1 25

Pravara, madhyama and avara shuddhi was considered by seeing vegiki response.

Hence, <10 vegas is considered as Avara shuddhi, 11-20 vegas are considered as

madhyama shuddhi and 21-30 vegas are considered as Pravra shuddhi.

Out of 30 patients, 7 patients (23.33%) were had Pravra shuddhi by Maniki

criteria of virechana, in which 2 patients (28.57%) were responded good, 4 patients

(57.17%) were moderately responded, 1 patient (14.28%) had shown poor response.

19 patients (63.33%) were had Madhyama shuddhi by Maniki criteria of

virechana, in which 7 patients (36.84%) were responded good, 8 patients (42.10%) were

moderately responded, 4 patients (21.05%) had shown poor response.

4 patients (13.33%) were had Avara shuddhi by Maniki criteria of virechana, in

which 3 patients (75%) were moderately responded, 1 patient (25%) had shown poor

response.

Graph No.24. Showing the distribution of patients by type of shuddhi obtained

and response.

Distribution of Pt.'s by Type of Shuddhi & Response

7

19

42

7

0

4

8

31

41

0

5

10

15

20

Pravara Madhyama Avara

Type of Shuddhi Obtained

No.

of P

t.'s

No. of Pt. G.R. M.R. P.R.

Observations & Results 108

OVERALL RESULTS

Table No. 46. Showing the overall results of the treatment.

Sl. Response No. of Pt.’s %

01. Good response 9 30

02. Moderate response 15 50

03. Poor response 6 20

04. No response 0 0

Out of 30 patients, 9 patients (30%) have shown good response, 15 patients (50%)

responded moderately and only 6 patients (20%) were shown poor response.

Graph No. 25. Showing the overall results of the treatment.

Overall Response of the trerapy

30%

50%

20% 0%

Good response Moderate responsePoor response No response

Observations & Results 109

DATA RELATED TO PARAMETERS

Table No. 47. Showing the Subjective parameters before and after the treatment.

Panduta Arohanayasa Dourbalya Bhrama Agnimandya Sl. No.

OPD No. BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF

01. 5305 2 1 0 1 1 0 2 1 0 2 1 0 2 0 0 02. 5543 2 2 0 1 1 0 1 1 0 1 1 0 2 1 0 03. 4465 2 2 1 2 2 1 2 2 1 2 1 1 2 1 1 04. 5548 2 1 0 1 1 0 2 1 0 2 2 0 0 0 0 05. 5317 1 1 0 0 0 0 1 0 0 1 0 0 2 0 0 06. 5489 1 0 0 0 0 0 2 1 0 2 2 0 2 0 0 07. 697 2 1 0 1 0 0 2 2 0 1 0 0 2 0 1 08. 2718 3 2 1 3 2 1 3 2 1 3 2 0 2 1 0 09. 2684 1 1 0 1 0 0 1 1 0 1 1 0 2 0 0 10. 1148 2 1 0 0 0 0 2 1 0 2 1 1 2 1 0 11. 1860 2 1 1 1 1 0 1 1 0 1 0 0 0 0 0 12. 2598 1 0 0 2 2 1 2 2 1 2 1 1 2 1 0 13. 2342 1 1 0 0 0 0 1 1 0 1 1 0 2 0 0 14. 2384 1 0 0 1 1 0 2 2 1 2 1 1 2 1 0 15. 2717 2 2 1 1 1 0 1 1 0 1 0 0 2 0 0 16. 2719 1 0 0 1 1 0 0 0 0 0 0 0 2 0 0 17. 2720 1 1 0 1 1 1 1 0 0 1 0 0 0 0 0 18. 2496 2 1 1 1 1 0 2 2 1 2 1 1 2 0 1 19. 2721 1 1 0 1 1 0 1 0 0 2 1 0 2 0 0 20. 2724 3 2 1 2 2 0 3 2 0 3 2 1 2 0 0 21. 2726 2 2 1 2 1 1 2 2 0 1 0 0 2 1 0 22. 2716 1 1 0 0 0 0 1 1 0 2 0 0 0 0 0 23. 2437 1 0 0 1 0 0 1 0 0 1 1 0 2 0 0 24. 2387 2 2 1 2 2 1 2 1 0 2 2 1 2 1 1 25. 2722 2 2 1 0 0 0 1 0 0 1 0 0 2 0 0 26. 2858 1 1 0 1 0 0 1 1 0 1 1 0 2 1 1 27. 2760 1 0 0 1 1 1 2 1 0 2 1 1 2 0 0 28. 1143 1 1 0 1 0 0 1 1 0 1 1 0 0 0 0 29. 5678 1 1 0 1 1 0 1 0 0 1 1 0 2 0 0 30. 5819 2 1 1 2 1 0 2 2 0 2 1 0 2 0 0

BT – Before treatment; AV – After Virechana; AF – After follow up.

Observations & Results 110

Table No. 48. Showing the Objective parameters before and after the treatment.

Hb in Gm/dl RBC mil /cumm

PCV in%

MCV in Cumm

MCHC in %

Blood smear

Sl. OPD

BT AV AF BT AT BT AT BT AT BT AT BT AT

01. 5305 9.82 10.2 11.22 3.59 3.88 29 32 80.7 82 33.7 34 2 1

02. 5543 10.55 10.7 11.22 3.50 3.81 30 35 83.3 92 34 32 1 1

03. 4465 9.11 9.3 9.72 3.41 3.68 28 30 82 81.5 32.5 32 1 1

04. 5548 11.92 11.95 12.6 4.16 4.38 35 37 84 88 34 34 0 0

05. 5317 11.22 11.5 12.62 4.18 4.52 33 37 79 82 34 34 1 0

06. 5489 11.22 11.3 11.92 3.98 4.11 32 33 84.4 86 34 34.5 1 0

07. 697 10.55 10.6 11.22 3.72 3.81 31 33 83.7 86 33 34 1 1

08. 2718 6.33 7.3 9.11 2.88 3.22 19 28 58 86 21 28 3 1

09. 2684 10.54 10.55 11.92 3.42 4.22 30 37 87 88 35 35 1 0

10. 1148 12.62 12.9 13.3 4.42 4.7 38 40 85 85 33 33.5 0 0

11. 1860 8.44 8.5 9.11 3.22 3.62 27 30 84 84 31 30 2 2

12. 2598 9.26 10.1 9.26 3.39 3.41 30 29 90 85 31 32 2 2

13. 2342 11.22 11.22 11.54 4.12 4.21 35 37 85 88 31 32 1 0

14. 2384 11.22 11.22 12.62 4.09 4.49 36 38 87 88 31 34 1 0

15. 2717 9.11 9.5 10.5 3.26 3.48 29 31 89 89 31 32 2 1

16. 2719 10.54 10.57 11.22 3.72 4.11 32 34 86 86.5 32 33 1 1

17. 2720 9.11 9.20 9.26 3.88 3.41 29 30 85 88 31 31 2 1

18. 2496 9.82 10.5 9.86 3.66 3.72 30 31 83 84 32 32 1 1

19. 2721 11.92 11.9 12.24 4.18 4.31 37 38 88 88 32 32 0 0

20. 2724 7 7 8.44 2.32 3.04 24 27 86 90 29 31 3 2

21. 2726 8.42 8.5 9.26 3.11 3.52 27 29 87 88.8 31 32 2 2

22. 2716 11.22 11.2 11.64 3.98 4.28 35 38 89 90 32 31 1 0

23. 2437 10.556 10.6 11.22 4.0 4.11 32 34 80 83 33 33 1 0

24. 2387 8.44 8.3 9.86 3.67 3.76 30 30 83 85 30 31 2 2

25. 2722 12.62 12.68 12.68 4.48 4.63 40 40 88 88 31.5 32 0 0

26. 2858 10.55 10.6 10.84 3.62 3.96 32 33 88 89 32.8 33 1 1

27. 2760 11.22 11.3 11.92 4.08 4.21 34 37 85 87 33 33 1 0

28. 1143 11.22 11.3 11.92 4.12 4.16 34 37 88 88 32 32 1 0

29. 5678 11.22 11.3 11.92 4.12 4.48 34 36 86 83 31 33 1 0

30. 5819 9.88 9.0 11.92 3.53 4.18 31 36 86 86 32 33 1 0

BT – Before treatment; AV – After Virechana; AF – After follow up.

Observations & Results 111

Table No. 49. Showing observation during Virechana therapy.

Deepana Pachana

Snehapana Virechana karma Sl. No.

OPD No.

2D 3D 1D 30 ml

2D 60 ml

3D 90 ml

4D 120 ml

T in ml

D3 D4 Dose in

gms

TA am

IV am

LV pm

A B C KA M1 M2

01. 5305 - + + + + + 300 - + 40 7 8.30 2 - + - + + - 02. 5543 - + + + + - 180 + - 40 7.30 9 1.30 - + - + - + 03. 4465 + + + + - 180 + - 40 7.30 8.45 1.15 - - - + - + 04. 5548 - + + + + - 180 + - 35 7 8.30 1 - + + + + - 05. 5317 - + + + + + 300 - + 40 7.45 8.45 1.45 - + - + - + 06. 5489 - + + + + - 180 + - 40 7.30 8.45 2 - + - + + - 07. 697 - + + + + - 180 + - 40 7 8.45 2 - + - + + - 08. 2718 - + + + + - 180 + - 40 7 8.35 2 - + - + - + 09. 2684 - + + + + - 180 + - 40 7.30 8.30 2.10 - - + + - + 10. 1148 - + + + + - 180 + - 40 7.30 9 2.35 - + - + + - 11. 1860 - + + + + + 300 + - 45 7 9.15 2.45 - - + + - + 12. 2598 + + + + - 180 + - 35 7 8.45 2.10 - - + + + - 13. 2342 - + + + + + 300 - + 45 7 9 2.30 - - + + + - 14. 2384 - + + + + - 180 + - 40 7.30 8.40 2.45 - + - + - + 15. 2717 - + + + + + 300 - + 45 7 8.30 3 - + - + + - 2D – 2 days; 3D – 3 Days; 1D – First Day; 2D – Second day; 3D – Third day; 4D – Fourth day; T – Total dose; D3 – Number of patients taken snehapana for 3 days; D4 – Number of patients taken snehapana for 4 days; TA – Time of drug administration, IV – Intiation of first vega; LV – Time of last vega; A – Number of patients who had passed Vegas in between 1 to 10; B – Number of patients who had passed Vegas in between 11 to 20; C – Number of patients who had passed Vegas in between 21 to 30; KA – Kaphantam observed; M1 – The Maniki of 2000 ml and below; M2 – The Maniki of 2000 ml and above.

Table No. 49. Showing observation during Virechana therapy.

Deepana Pachana

Snehapana Virechana karma Sl. No.

OPD No.

2D 3D 1D 30 ml

2D 60 ml

3D 90 ml

4D 120 ml

T in ml

D3 D4 Dose in

gms

TA am

IV am

LV pm

A B C KA M1 M2

16. 2719 - + + + + - 180 + - 40 7.30 8.45 2.45 + - - + + - 17. 2720 + - + + + + 300 - + 45 7 9.20 2.30 - + - + - + 18. 2496 - + + + + - 180 + - 40 7 8.30 2.15 - + - + + - 19. 2721 - + + + + - 180 + - 40 7.30 8.45 1.45 - + - + + - 20. 2724 - + + + + + 300 - + 40 7 8.20 1.45 - + - + - + 21. 2726 - + + + + + 300 - + 45 7 8.15 2.50 - + - + - + 22. 2716 + - + + + - 180 + - 45 7 9 3 + - - + + - 23. 2437 - + + + + + 300 - + 40 7.45 8.35 3 + - - + + - 24. 2387 - + + + + - 180 + - 40 7 8.25 2.30 - + - + - + 25. 2722 - + + + + - 180 + - 40 7.30 8.45 2.45 - + - + - + 26. 2858 - + + + + - 180 + - 40 7.30 8.50 2.10 - + - + + - 27. 2760 - + + + + - 180 + - 40 7 9 1.30 -- + - + - + 28. 1143 + - + + + - 180 + - 35 7.30 9.45 1.45 + - - + + - 29. 5678 - + + + + - 180 + - 40 7 9 2.30 - - + + + - 30. 5819 - + + + + + 300 - + 40 7.30 8.45 2.45 - - + + - + 2D – 2 days; 3D – 3 Days; 1D – First Day; 2D – Second day; 3D – Third day; 4D – Fourth day; T – Total dose; D3 – Number of patients taken snehapana for 3 days; D4 – Number of patients taken snehapana for 4 days; TA – Time of drug administration, IV – Intiation of first vega; LV – Time of last vega; A – Number of patients who had passed Vegas in between 1 to 10; B – Number of patients who had passed Vegas in between 11 to 20; C – Number of patients who had passed Vegas in between 21 to 30; KA – Kaphantam observed; M1 – The Maniki of 2000 ml and below; M2 – The Maniki of 2000 ml and above.

Table No. 50. Showing statistical results of subjective and objective parameters.

Parameter Mean S.D. S.E. t value p value Remarks Panduta 1.233 0.43 0.0785 15.71 <0.001 H.S. Arohanayas 0.833 0.592 0.108 7.71 <0.001 H.S. Dourbalya 1.366 0.614 0.112 12.201 <0.001 H.S. Bhrama 1.266 0.583 0.106 11.94 <0.001 H.S. Agnimandya 1.5 0.776 0.141 10.638 <0.001 H.S. Hb% 0.842 0.598 0.109 7.724 <0.001 H.S. RBC count 0.429 0.672 0.122 3.516 <0.01 H.S. PCV 2.533 1.907 0.348 7.278 <0.001 H.S. MCV 2.823 5.11 0.934 3.022 <0.01 H.S. MCHC 1.083 1.53 0.279 3.881 <0.001 H.S. Blood smear 0.53 0.571 0.104 5.096 <0.001 H.S.

STATISTICAL CONCLUSION

The analysis is done by using paired t test to know the effect of drug before and

after the treatment.

Among subjective parameters the Panduta, Dourbalya, Bhrama, Agnimandya

shows more highly significant than Arohana ayasa. Among all the parameters Panduta

shows more highly significant than others. (by comparing t and p values).

The parameters Agnimandya shows more net mean effect with more variation

whereas the parameters Arohana ayasa shows less net mean effect. The parameter

Panduta shows less variation (By comparing mean and SD).

Among objective parameters except the parameters RBC count and MCV all

other parameter shows more highly significant. (By comparing p value).

Again the parameter except Hb and PCV, shows more highly significant than

others (By comparing t value).

The parameter MCV shows more net effect with more variation. The RBC count

shows less net mean effect. The parameter blood smear shows less variation. (By

comparing mean and SD).

Among the subjective parameter the Panduta shows uniform effect and among

objective parameter MCV shows uniform effect after the treatment. (By comparing co-

efficient of variation).

Observations & Results 114

DISCUSSION ON LITERARY

Virechana karma is most commonly used shodhana therapy in general practice. It

means elimination of vitiated doshas through adhomarga. Along with ushna, tikshna,

vyavayi, vikashi properties, these drugs consists predominance of prithwi and apa

mahabuta and adhobhagahara prabhava. Virechana is mainly indicated for pitta pradhana

vyadhis and also pitta dosha associated with other doshas too. As we know “Pittam Tu

Sweda Raktayoho”, so it can also be indicated for rakta pradoshaja vyadhis.

Virechana therapy has three necessary steps to follow, poorvakarma,

pradhanakarma and paschyat karma, which are having their own significance. In

poorvakarma pachana snehapana, swedana are the measures to follow, which are

necessary for vriddhi vishyandana, paka and srotomukha vishodhana.

The Panchakarma is mainly indicated in chronic diseases where many toxins

(malas) will be present. These toxins are soluble in the fat media, the medicated ghrita

used as snehana will reach the cellular level and does shithilata of vitiated doshas (toxins)

thereby bring them to koshta for elimination.

In pradhanakarma, the given virechana yoga will enters the systemic circulation

after digestion and also brings some remained doshas to koshta. Then it increases the

peristalsis thereby eliminates the vitiated doshas (malas).

After shodhana, the agni becomes imbalance i.e. it may be unable to digest the

normal consumption of food. Therefore, samsarjana karma should be followed by means

of manda, peya, vilepi, krita-akrita yusha, krita-akrita mamsarasa. Depending on the

shuddhi achieved. So that the agni can be brought back to its equilibrium state.

Discussion 111

For assessment of Virechana, Vegaki, Manaki, Antaki and Laingiki criteria are

mentioned in the classics, Laingiki criterion has got more importance than the others.

Because, of the fact that, the samyka virakta lakshanas can be observed before achieving

the parameters mentioned for pravara shuddhi in terms of vegiki, manaki and antaki.

Once samyak virakta lakshanas are observed, the vega must be stopped by inducing

vamana, thereby preventing the possibility of atiyoga.

Panduroga is the most common disease, which is explained by all the acharyas. It

is pitta pradhana tridoshas vyadhi, where dhatu parinama (specially rasa to rakta) is

mainly affected. Acharya Charaka has mentioned Panduroga in santarpanajanya vyadhis.

By term santarpana, we may take it as strengthening and restorative diet. The Nidana

sevana may restrain normal process by providing toxic substances and may lead to

disturb the digestive and assimilative processes. This may be due to mandagni thereby

causing pitta pradhana tridosha prakopa, results in Panduroga.

The Anaemia, which results from deficiency of iron and characterized by the

reduction of haemoglobin concentration appropriate for age and sex, red cell count,

packed cell volume, to below the normal level, is called iron deficiency Anaemia.

The alpa rakta causes decrease in the functions of jeevana, mamsapushti,

dhatuposhana and vardhana, bala and varna of the body. So also the decrease in blood

affects its various functions related to nutrition, respiratory, cardiovascular and defence

mechanism of the body. Moreover, the signs and symptoms said in Anaemia, like fatigue,

weakness, pale skin, rapid heart beat, shortness of breath, dizziness, irritability, numbness

or coldness in hands and feet and headache are same as samanya lakshanas of Panduroga.

By considering the above similarities we can come to a conclusion that the Panduroga

explained in Ayurveda and Anaemia mentioned in modern science are almost similar

condition.

Discussion 112

When we look into the Chikitsasutra of Panduroga all the acharyas opines first

sneha should be given with the ghritas indicated in Panduroga, there after shodhana must

be adopted by means of Vamana and Virechana. According to acharya Dalhana, urdhwa

shodhana (Vamana) is contraindicated in Panduroga, but mridu vamana can be performed

in accordance with ritu, desha, prakriti, kala and Shareera. As pitta is main doshas

involved in samprapti of Panduroga. Virechana is more suitable shodhana therapy, hence,

was chosen for the study.

DISCUSSION ON MATERIAL METHODS

01. Research design

It is an observational study. The efficacy of virechana karma was observed in 30

patients, who were selected incidentally form OPD, IPD of D.G.M. Ayurvedic Medical

College, Gadag.

02. Drugs used for Virechana karma

A) Trikatu churna – The drugs chosen because, it is both agni deepaka and ama

pachaka and also ruchikaraka. This churna was given 3-6 gms three times a day

before food till the appearance of nirama lakshanas.

B) Dadima ghrita – Snehanartha Dadima ghrita is indicated in Pandurogadhikara,

hence it was chosen for abhyanatara snehapana. Its ingredients shows the properties

like deepaka, pachaka, vatanulomaka, rochaka, krimighna, raktashodhaka. Dadima

ghrita is palatable to the patient. It was administered in arohana vidhi.

Discussion 113

C) Murchita tila taila and ushna jala – For abhyanaga murchita tila taila was used and

for swedana ushna jala snana was performed. In Panduroga swedana is

contraindicated, even then, it is mentioned in classics that we can do mridu

swedana. Hence, for the purpose of mridu swedana, ushanajala snana was advised.

This was performed for 3 days and it can also be considered as vishrama kaala.

D) Vyoshadi Gutika – For the purpose virechana Vyoshadi gutika is used because -

It is effective Virechana yoga.

Its ingredients are easily available.

Method of preparation is very simple.

It is palatable and is in leha form.

It is upakalpa of trivirt, can be considered as sukha virechana, thus safe to use.

Dose : - The dose of the Vyoshadi Gutika mentioned in classics is 1 pala i.e. 48

gms, can be considered as maximum dose. In the present study according to the koshta

and bala of the patient 35, 40, and 45 gms were used as pravara, madhyama and uttama

matra respectively. In this study 3 patients were given 35 gms, 21 patients were given 40

gms and 6 patients 45 gms was given as uttama matra.

Anupana : - All the patients were given sheetajala as anupana as mentioned in the

classics. The action of the drugs started within 1-3 hours after its administration.

Discussion 114

03. Inclusion and Exclusion criteria

Only mild to moderate (i.e. above 6 gms and below the normal range of Hb) type

of anaemia (Panduroga) cases were taken for the study.

Age factor was fixed between 18-60 years. Below 18 years and above 60 years

patients are unable to withstand the procedure of virechana therapy and bala and vriddha

are contraindicated too.

The patients who are fit for virechana, were only selected for the study i.e. even

though the patient had the lakshanas of Panduroga, if he had the conditions of virechana

ayogya was excluded.

The patients suffering with severe systemic disorders like Raktarbuda, Asrgdhara,

Raktapitta, Yakrit-pleeharoga, Raktarsha, Pleehodara, Pittaja prameha were also excluded

to avoid the complications.

04. Laboratory investigation

Estimation of haemoglobin is first and foremost test in any suspected case of

anaemia. Thus, it was carried out three times in each patient during this study.

Blood smear examination was performed for the study of morphological features,

thereby assessing the type of Anaemia.

An alternative method to diagnose and detect the severity of Anaemia is by

measuring red cell indices. Thus, PCV, MCV and MCHC were also tested.

Leucocytes and platelet count was done to distinguish pure Anaemia form

Pancytopenia.

Discussion 115

Though ESR a non-specific test for Anaemia, it was done as a clue to underlying

organic disease and urine routine and microscopic tests were also done to rule out other

systemic disorders.

05. Study duration

3 days deepana-pachana, 3-5 days for snehapana, 3 days for abhyanga and mridu

swedna, 1 day virechana, then 3-5 days samsarjana, includes 13 to 17 days for virechana

therapy.

13 to 17 days follow up was done to observe proper virechana therapy.

Hence, the total study duration was 30 days. After the completion of the study of

the study, the patient was advised for shamanoushadhis.

06. Criteria of Assessment

As this study mainly deals with the evaluation of efficacy of the virechana

therapy, the subjective and objective parameters were considered for the assessment of

result. Though various symptoms are present in the Panduroga, for the purpose of the

assessment the cardinal symptoms or the symptoms which were found more in this study

were taken for the subjective assessment. They are panduta, arohanayasa, dourbalya,

bhrama and agnimandya. For objective assessment Hb%, RBC count, PCV, MCV,

MCHC and smear study were taken into consideration.

08. Overall assessment

The overall assessment was declared only on the basis of improvement in

haemoglobin percentage along with clinical assessment (subjective parameters).

No change in Hb – No response.

Improvement in Hb – 0.01 – 0.5gms Mild responded.

Improvement in Hb – 0.51 – 1 gms Moderate responded.

Improvement in Hb – 1.01 gm and above Good responded.

Discussion 116

The Panduta after treatment was grade 0 in 20 patients. Among them 5 patients of

grade 2, 15 were of grade 1 before the treatment. Remaining 10 patients were of grade 1

after the treatment, among them 8 patiants were of grade 2 and 2 patients were of grade 3

before the treatment.

The Arohanayasa was observed in 24 patients. Among them 17 patients were of

grade 1 before the treatment, of them 15 were of grade 0 after the treatment and 2 were

not responded i.e. grade 1 even after treatment. Among remaining 7 patients 6 were of

grade 2 and only one patient was of grade 3 before the treatment, of them 5 patients were

of grade 1 and 2 were of grade 0 after the treatment.

Dourbalya and Bhrama were found in 29 patients. Among them 2 were of grade 3

before the treatment. Among them 1 patient was of grade 0 and 1 patient was of grade 1

after the treatment. 13 patients were of grade 2 before the treatment of them 4 patients

were were grade 1 and 9 patients were grade 0 after the treatment. Remaining 14 patients

were of grade 1 before the treatment and were shown grade 0 after the treatment.

Agnimandya was found in 25 patients and all the patients were of grade 2 before the

treatment. Among them 5 patients were grade 1 and 20 patients were of grade 0 after the

treatment.

Discussion 117

DISCUSSION OF OBSERVATIONS

All the cases were taken from OPD & IPD of DGM Ayurvedic Medical College.

Postgraduate departments. Special medical camps were also conducted in the college for

selecting the patients. Observed features in the patients during the study were recorded in

the case-sheets and the observations were analyzed and tabulated after completion of

clinical study. These observational finding are discussed below.

1) Age

In the sample of 30 patients, it was observed that the maximum number of patients

(46.66%) was from the age group 18-24 years. Among them 11 patients were females and 3

were male and also 12 of them were students. The incidence may because of more iron loss

during menstruation, increased demand of iron during the age group and increased stress

and strain, thereby irregularity in diet.

2) Sex

The sex wise distribution of patients reveals that Panduroga was observed more in

females (73.33%) than male (26.66%) approximately 3:1 ratio.

Higher incidence in female is found because of regular menstrual blood loss; blood

loss during delivery, pregnancy, and lactation requires more Iron if not compensated results

in Anaemia. It may also be due to imbalance, irregular diet intake, mental and pshysical

stress.

3) Religion

In this series most of the patients were Hindus i.e. 83.33% and a lesser portion

belonged to Muslim community. i.e. 16.66%. From this it can be inferred that most of the

Hindus are vegetarians and this incidence may be due to imbalance diet and Prolonged

Malnutrition because of lack of awareness regarding the importance of diet.

Discussion 118

4) Occupation

In the present study maximum number of patients were students. (36.66%) and

23.33 % were household work. This may be due to excessive mental stress, irrelevant,

inadequate and improper diet. In most of these patients, it was observed that Diwaswapana

was common, leading to agnimandya, which can cause Dhatwagnimandya, which is a

cause of improper digestion results in Panduroga. In the same way Ratrijagarana was found

maximum which can also be a cause for this disease.

5) Socio economic status

The larger numbers of patients were from middle class 53.33%, 30% were from

upper middle class & 16.14% were from poor class.

The patients form middle class cannot afford expensive nutritious food. However,

middle class females due to poor pre and postnatal care are more prone to this disease. As

well as they are not caring for proper diet yet needed time and always worrying for the

family responsibilities, which leads to mental tensions. The people of upper middle class,

though their diet is adequate, but proper absorption and assimilation is also necessary for

its utilization. Thus, lack of supplementation of dhatu at required level, results in

Panduroga.

6) Food habit

In this clinical study, it was observed that most of them were vegetarians 70% and

remaining 30% were mixed type of food habit.

According to physiological needs, the food which has consumed should have a

active principles that triggers the production of haem yet times, when it is needed. As

non-vegetarians can consume the liver and bone marrow of animals (Goat), to

supplement the loss of production of haem, where as it is lacked in vegetarians diet. That

may be the cause, observed during my study that 70% of vegetarians are more prone to

Panduroga.

Discussion 119

7) Prakriti

Majority of cases (53.33%) were having Pitta Shleshmaja prakriti and 26.66%

were having Vata Pitta Prakriti

It is observed that may be due to these kind of prakriti persons have consumed

pittaprakopaka ahara and vihara results into pittavirddhi and as the person having these

kinds of prakriti are prone to the incidence of the disease Panduroga.

8) Koshta and Agni

In my study it was observed that 22 patients (73.33%) were having the mandagni

and madhyama koshta, may be due to predominance of kapha dosha, which place an

important role in proper digestion and assimilation of the nutrients. So that the symptoms

like Panduta, Dourbalya, Agnimandya, Bhrama occurs compare to other category (Koshta

and Agni) of the patients.

9) Nidana

Aharaja

About 28 patients (93.33%) had the history of Amla sevana, 26 patients (86.66%)

were of kshara and teekshna sevana, 22 patients (73.33%) were of masha sevana and

about 20 patients (66.66%) were of lavana and atiushna sevana and some 15 patients

(50%) had the history of tila sevana. Among them most of the patients were vegetarians.

It may be due to lack of awareness regarding diet consumption such kind of diet vitiates

tridosha, specially pittadosha resulting the disease panduroga.

Vihara

Divaswapna (86.66%), Ativyayama (66.66%) and Ratrijagarana (63.33%) were

found maximum as most of them were students and households. Nidra viparyaya causes

Agnimandya and Ativyayama causing incomplete digestion and production of Ama,

which vitiates rasa and rakta results in Panduroga.

Discussion 120

Manasika

In the present study krodha and chinta were found in 93.33% and 66.66% of cases

respectively. This incidence may be due to the fact that most of the patients were students

and household in this study. The mental stress may cause inadequate consumption of the

diet and improper digestion, thereby resulting in Panduroga.

11) Lakshana

In all the 30 patients, mild to moderate degree of Panduta was noted, which is

pratyatma lakshana of Panduroga. It may be due to ojakshaya, raktakshaya and vitiation

of pittadosha associated with other doshas. After treatment it showed the mean effect

1.233 and p value <0.001 which is highly significant.

Arohanayasa was found in 24 patients, it may be due to less oxygen carrying

capacity of blood to the vital organs. So heart has to pump more to provide proper blood

flow. The mean relief found was 0.833 and p value <0.001 which is highly significant.

Dourbalya and Bhrama were found in 29 patients. Hence, it can be inferred that

these symptoms are also most prominent in this disease. This is due to Rasa raktadi dhatu

kshaya. The mean effect found after the treatment was 1.366 and 1.266 respectively and p

value <0.001 which are highly significant.

Agnimandya was noticed in 25 patients, which may be results out of Nidana

sevana, where Pachaka pitta, Samanavata and Ranjaka pitta are mainly involved. Its

mean effect after the treatment was 1.5 and p value <0.001 which is highly significant.

12) Types of Panduroga

It shows 45% of cases were pittaja pandu, followed by 35% cases of Kaphaja

pandu and remaining 20% of cases were of Vataja pandu. Pittaja pandu is the commonest

type of pandu found in the study. The probable cause may be that, most of the patients were

pitta-dominating prakriti and involvement of pittaja Nidana was noticed.

Discussion 121

DISCUSSION ON TREATMENT

Deepana-pachana with Trikatu was given for 2-3 days, 3-6 gms thrice daily till

the appearance of Nirama lakshanas. As Pandu is santarpanajanya vyadhi where

Agnimandya and symptoms of Ama can be appreciated. It was observed that all the

patients got nirama lakshanas within 2-3 dyas. In that 2 patients had complaint of burning

sensation and irritation in the chest region, 10-15 minutes after the intake of the medicine.

In such case dose was reduced and advised to consume with excessive warm water.

Dadima ghrita was used for Snehapana. Starting with 30 ml and was given within

7-8 am in all the patients. Snehapana was continued for 3-4 days in arohana vidhi. Thus,

in the present study maximum ghrita given to a patient was 300 ml and minimum was

180 ml. It was observed that 30 ml of Dadima ghrita was digested within 180 minutes in

27 patients and 3 patients took more than this time i.e. 180-240 minutes. 60 ml of ghrita

was digested in between 240-360 minutes, where as time taken to digest 90 ml of ghrita

was 360-480 minutes in 28 minutes where as only 2 patients were digested within 360

minutes. Sukhoshnajala was adviced as Anupana, which is kaphahara, deepaka,

amapachaka, vatanulomaka, thus helpful in proper digestion of administered senha.

The sneha imparts its qualities to all the dhatus gradually, once all the dhatus gets

saturated with sneha, their qualities like snigdhata and mriduta manifests in the twak.

Snehapana removes the obstruction to the gati of the vata, Vatanulomana takes place.

Hence, individual may feel laghuta and vimalendriyata.

Snehapana itself may act like langhana due to diet restriction during the course of

snehapana. This may another reason for manifestation of above symptoms. By excessive

amount of sneha, excessive secretion in srotas may takes place and hence produces

vishyandana. When snigdhata guna of the body reaches optimum level, invidual will start

Discussion 122

showing disliking towards snehapana. Shodhanga snehapana is tedious process of

consumption of higher dose of sneha, by following restriction in the diet. Thus, glani may

be observed in the individual. Thus, during everyday of snehapana. Samyak snigdha

lakshanas were examined thoroughly.

According to classics virechana should be administered just after shleshma kala.

Keeping this in mind the suitable matra was administered by considering Koshta, Agni

and at proper time. Hence, the Virechana yoga was administered around 7-8 am. Before

the administration observations like pulse, BP, respiration rate were noted to observe the

changes. The parameters like vegiki, maniki, antaki and laingiki were also noted by

interrogation with the patient.

In the present study it was noted that, 7 patients had below 10 vegas, 19 patients

had 10-20 vegas and only 4 patients had above 20 vegas. Hence, it can be inferred that,

maximum patients has shown madhyama type of shodhana. About 6 patients shown the

symptom of vomiting and nausea during virechana vega kala. It may be due to early

administration of virechana yoga, alpa satwa and also due to the properties of virechana

dravyas.

The quantity of Vegas was measured by asking the patient about the appropriate

quantity of single vega. It was observed that 14 patients were passes Vegas of 2000 ml,

and above and 16 patiants were less than 2000 ml. Approximately, 2200 ml of maximum

amount of drava (vitiated doshas) was measured in a patient who passed 24 vegas and

1400 ml was minimum amount found in a patient who passed 7 vegas.

All the patients had manifested the features of kaphanta in between 5-30 to 8-30

hours after administration of virechana dravyas. It was appropriated by frothy type of

Vega pravritti.

Discussion 123

Vata, purisha, pitta and kapha kramataha nissarana, Shareera karshya, dourbalya,

Shareera laghuta, srotoshuddhi and vatanulomana were observed in all the patients as

samyak virakta lakshanas. Shareera kshaya was observed by weight loss after virechana

compared to before the virechana others symptoms were known by interrogation with the

patients.

In this study during follow up no shamanoushadhis were administered in order to

observe the long-lasting effect of virechana therapy. It was noticed that the effect of

virechana is more in long-lasting compare to immediate effect. It may be due to the

additive contribution of the extraneous variables like consumption of pathya ahara and

vihara mentioned in the context of Panduroga.

When we look into the concept of dhatu parinama, acharya Sushruta opines, rasa

develops from the diet in one day. The circulating rasadhatu, transporting the nutrients

stays in each one of the remaining six dhatus for a period of 3015 kalas (5 days).

Therefore, it takes for the rasa, one month to be formed shukra in men and artava in

women. The total time taken for conversation is 30 days. But according to Charaka, it

depends on the agni status of the person. By considering this the efficacy of virechana

was observed after 15 days of follow up.

In the present study, 42 patients were registered. In that 4 patients were not

satisfied the criteria of the study, 5 patients were discontinued the treatment before the

virechana karma, whereas 3 patients were discontinued at the time of follow up. Among

30 patients 9 patients (30%) were shown good response, 15 patients (50%) shown

moderate response whereas, 6 patients (20%) were shown poor response. Poor response

may be either due to not completely adopted follow up or shuddhi of Virechana is not up

to the mark.

Discussion 124

It is a single group observational study, it showed remarkable changes in signs

and symptoms as well as Hb, RBC count, PCV and smear study, which are statistically

significant. Among subjective parameters Panduta, Bhrama, Dourbalya showed much

significant. The parameter Hb% and Arohana ayasa almost have the same significant

effect. Form this we may conclude that, virechana therapy corrects agni, dhatwagni

mandya and srotosanga resulting out of ama, which are the basic causes for Panduroga.

Based on the results observed in the present study it can be undoubtedly conclude that

Virechana is effective therapy in Panduroga in which alone can give the mean effect of

Hb up to 0.85 gm including extraneous variables.

DISCUSSION ON THE EFFECT VIRECHANA THERAPY IN PANDUROGA

Samshodhana, samshamana and pathya ahara-vihara are mentioned in the classics

for the management of Panduroga. Among samshodhana, vamana and virechana are

indicated, by considering the opinion of Acharya Dalhana, virechana was chosen for the

study.

The factors, which can influence by the virechana concern to Panduroga are as

follows –

01. Panduroga is a pitta pradhana tridoshaja vyadhi, where rasa and rakta are mainly

affected. Virechana is main line of treatment for pitta dosha and it is not viruddha

Chikitsa for vata and kapha dosha, which are associated in this disease.

02. Acharya Charaka has mentioned it as Santarpanajanya vyadhi where dhatu

parinama is mainly affected. Virechan is apatarpana type of Chikitsa, which

could be helpful by eliminating vitiated doshas correcting srotodushti, thereby

producing bala and varna.

Discussion 125

03. Virechana acts mainly on pittadhara kala. Acharya Dalhana, in the context of

vishavega Chikitsa, it is mentioned that pittadhara kala and majjadhara kala are

one and the same. Hence, virechana can also acts on majjadhara kala. Sarakta

majja, corresponds to the red bone marrow, which is site of production of RBC’c.

04. When we look into absorption of iron, it is said that, iron is mainly absorbed in

the duodenum and the proximal jejunum, which is the site of pittadhara kala.

Even in modern it is mentioned that the factors, which determine this mucosal

intelligences are unknown, when demand is more there is increase in iron

absorption.

05. Transferrin, which serves to transport the iron form the site of absorption is

synthesized mainly in the liver parenchymal cells.

06. The main source of iron transport and utilization is the destruction of RBC than

that of intestinal absorption and storage. The site of destruction RBC is pleeha

(Spleen).

07. Erythropiotin, a haemopiotic growth factor is a glyco-protein produced mainly in

the kidney and to a small extent in the liver (Yakrit), in response of cellular

hypoxia.

08. The most common cause of maturation failure is not the lack of vitamin B12 in

the diet. But, failure of absorbs form the gastrointestinal tract. The intrinsic factor

which is secreted by the parietal cells of the gastric glands (Amashaya), combines

with the Vitamin B12 of the food and makes this vitamins available for

absorption. Its larger quantity is stored in the liver.

09. In Ayurveda, yakrita – pleeha are said as moolas for the raktavaha srotas and

ranjaka pitta is situated in yakrit – pleeha and amashaya.

The above said factors may be the reason why, the virechana is effective in

Panduroga, by correcting the raktadushti.

Discussion 126

DISCUSSION ON THE EFFECT OF VYOSHADI GUTIKA IN PANDUROGA

Pharmacodynamics in Ayurveda is mainly based on the fundamental doctrines of

Panchamahabhoota and Tridosha, which govern the physiochemical and biological

phenomena respectively. On assessing the properties of Vyoshadi Gutika, the drugs are

having following properties –

01. Agnideepaka – Agnimandya specially, dhatwagni mandya is the main cause for

the disease Panduroga.

02. Tridoshahara – Panduroga is pitta pradhana, tridoshaja vyadhi.

03. Srotoshodhaka – Sanga type of srotodushti is found in Panduroga, which can

affect the dhatu parinamana.

04. Krimighna – Both Ayurveda and modern science accept the involvement of Krimi

(Worms) may be cause for Panduroga.

05. Rechaka – Expels both pakwa and apakwa malas present in the pathogenesis of

Panduroga.

06. Vatanulomana – Baleena vata is one of the factor involved in the samprapti of this

disease.

07. Raktashodhaka – As “Pradushya raktam” is the main condition mentioned in the

samprapti of this disease.

08. Yakrit uttejaka – By seeing explanation in Ayurveda and contemporary science,

the importance of part played by the yakrit can be revealed.

The above said factors may be responsible for the effect of Vyoshadi Gutika in

Panduroga used as Virechana yoga.

Discussion 127

CONCLUSIONS

01. Panduroga is a disease named after different vaivarnyas of the twak, mainly

Pandurvarna, it refers to shweta and Peeta mishrita varna.

02. Panduroga can occur as a main disease, symptoms or as a complication to other

diseases.

03. Panduroga is said as Santarpanajanya vyadhi where apatarpana type of treatment

like virechana karma is necessary to treat basic pathology.

04. Achary Dalhana opines that the urdwa shodhana is contraindicated in Panduroga

and moreover it is pitta pradhana tridoshajanya vaydhi, where pradushya rakta is

mainly appreciated. So Virechana therapy was chosen for the study.

05. After the period of observation, it can be said that Virechana therapy has more

long lasting effect than that of immediate effect, where extraneous variables are

also contributing in the total result.

06. In the present study, individually except RBC and MCV all the parameters show

highly significant.

07. In my view as duration of the study is inadequate and Virechana alone is not

complete treatment to cure the disease Panduroga, Virechana therapy followed

with indicated Sahamanoushadhis and Pathyapathya could give more beneficial

effects.

08. In the overall results, 9 patients were responded good, 15 patients were

responded moderately whereas 6 patients shown poor response.

Conclusion 128

Suggestions for the future studies

01. A similar study can be conducted on large sample.

02. Study on effect of repeated Virechana in Panduroga with longer duration.

03. A comparative study of Vamana and Virechana therapy in Panduroga.

04. A comparative study of Virechana therapy and standard shamanoushi in

Panduroga.

05. Study on additive efficacy of Virechana therapy in Panduroga.

Conclusion 129

SUMMARY

The thesis is entitled with- “Clinical evaluation of Virechana therapy in the

management of Panduroga”.

Panchakarma is a procedure by which vitiated doshas get eliminated from the

body. “Na Tesham Punarudbhavaha” indicates the importance of Panchakarma.

Virechana is specially indicated for Pittadosha and Pittadosha associated with other

doshas. Panduroga is Pittapradhana tridoshaja vyadhi where Rasa and Rakta are mainly

affected and is Santarpanajanya vyadhi. Thus virechana karma is most appropriate and

suitable procedure which is a variety of Apatarpana Chikitsa. In this study specially

indicated “Dadima Ghrita” for Snehapana and for Virechana “Vyoshadi Gutika” was

used.

The present study covered the following aspects;

1. Introductory part and Objectives.

2. Historical aspect of Virechana and Panduroga.

3. Description about Virechana therapy and Modern Purgatives.

4. Explanation regarding Panduroga, including Nidana panchaka and its Chikitsa.

5. Brief description about Anaemia with special reference to IDA.

6. Anatomical consideration of Virechana therapy and Pathogenesis of Panduroga.

7. Description regarding Materials and Methods of present study including Drug

review.

8. Observations of the present study, Results, Discussion, Summary, Conclusion and

finally Bibliography.

Summery 130

The study was conducted on a single group and all patients received Classical

Virechana therapy. The disease was diagnosed mainly on the classical signs and

symptoms and was further confirmed with Hematological study. The Drugs selected for

study were Trikatu Choorna for Deepana Pachana, Dadima Ghrita for Snehapana,

Murchita Tila taila for Abhyanga and for Virechana Vyoshadi Gutika which were

explained in detail in Drug review.

Observations were taken before the treatment, after the Virechana karma and after

the follow up study. Assessment was done on both subjective and objective parameters.

The effect of the therapy was statistically assessed by using Paired t-test, which was

significant.

The discussion pertaining to the review of literature, Materials and Methods,

observations, treatment and results, hypothesis of the effect of Virechana therapy as well

as Virechana with Vyoshadi Gutika in Panduroga were discussed to draw the logical

conclusion. It was found that Virechana shows long lasting effect if the patients follow

the Pathya apathya. Thus the extraneous variables are also contributing in the total effect.

Summery 131

INTRODUCTION & HISTORICAL REVIEW

1) Vagbhata, Ashatanga Hridaya Sutratshana Chapter 14 Shloka 1-2. 9th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.223.

Agnivesha, Charaka Samhita Sutrasthana Chapter 22 Shloka 1. 22nd ed. Varanasi:

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2) Vagbhata, Ashatanga Hridaya Sutratshana Chapter 14 Shloka 4. 9th ed. Varanasi:

Chaukhamba Orientalia; 2002.p.223.

3) Vagbhata, Ashatanga Hridaya Sutratshana Chapter 14 Shloka 5. 9th ed. Varanasi:

Chaukhamba Orientalia; 2002.p.223.

4) Ibid. 223.

Dalhanacharya, Sushruta Smahita Sutrasthana, Chapter 5 Shloka 3. 8th ed.

Varanasi: Chaukhamba Orientalia; 2005.p.19.

5) Agnivesha, Charaka Samhita Sutrasthana Chapter 16 Shloka 20. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.321.

6) Agnivesha, Charaka Samhita Kalpasthana Chapter 7 Shloka 46-50. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.923.

7) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 44-46. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.494.

Arundutta, Ashtanga Hridaya Chikitsathana Chapter 15 Shloka 2-4. 1st ed.

Varanasi: Chaukhamba Orientalia; 2000.p.701.

8) Agnivesha, Charaka Samhita Kalpasthana Chapter 7 Shloka 46-50. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.923.

9) Agnivesha, Charaka Samhita Sutrasthana Chapter 2 Shloka 9. 22nd ed. Varanasi:

Chaukhamba Orientalia; 1996.p.53.

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Chaukhamba Orientalia; 1996.p.51.

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Chaukhamba Orientalia; 1996.p.54.

12) Agnivesha, Charaka Samhita Kalpasthana Chapter 7-12. 22nd ed. Varanasi:

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132

13) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 17-19. 22nd ed.

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133

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134

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135

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26) Agnivesha, Charaka Samhita Sutrasthana Chapter 13 Shloka 47. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.268/

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Varanasi: Chaukhamba Orientalia; 2002.p.138.

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Varanasi: Chaukhamba Orientalia; 2000.p.250.

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Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit

Sansthan;Orientalia; 2004.p.86.

30) Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 20. 13th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.144.

136

Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 8-9. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.960.

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Chaukhamba Orientalia; 1996.p.960-961.

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33) Sharangadhara, Sharangadhara Samhita Uttara khanda Gudartha Depika Vyakya,

Chapter 4 Shloka 13. Chaukhamba Orientalia; (Jaikrishnadas 53). p.479-480.

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Varanasi: Chaukhamba Orientalia; 2002.p.144.

35) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 33. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.266.

36) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 26. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.1023.

37) Ibid. 27.

38) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 37. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.267.

39) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 20. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.1021-1022.

40) Ibid 21.

41) Y. T. Acharya, Astanga Sangraha Sutrasthana Chapter 27 Shloka 40. 11st ed.

Varanasi: Chaukhamba Orientalia; 1996.p.494.

42) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 13-14. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.962.

43) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 17. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.964.

Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 27. 13th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.145.

Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 39. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.267.

137

44) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 18. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.964-965.

Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 24. 13th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.144.

Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 38-39. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.267.

45) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 19-20. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.965.

Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 25. 13th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.144.

Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 40-41. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.267.

46) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 32. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.1024.

47) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 43-45. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.267-268.

48) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 25. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.1023.

49) Chakrapanidutta, Charaka Samhita kalpasthana Chapter 6 Shloka 25. Yadavaji

Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit

Sansthan;Orientalia; 2004.p.705.

50) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 29. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.1023.

51) Chakrapanidutta, Charaka Samhita kalpasthana Chapter 6 Shloka 29. Yadavaji

Trikamji acharya, reprinted. Varanasi: Chaukhamba Sanskrit Sansthan;

2004.p.705.

52) Sushruta, Sushruta Samhita Chikitsasthana Chapter 34 Shloka 3. 13th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.140.

53) Agnivesha, Charaka Samhita Sutrasthana Chapter 26 Shloka 67. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.514.

138

54) Sushruta, Sushruta Samhita Sutrasthana Chapter 46 Shloka 259. 13th ed. Varanasi:

Chaukhamba Orientalia; 2002.p.205.

55) Agnivesha, Charaka Samhita Sutrasthana Chapter 26 Shloka 13. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.492.

56) Satuskar R.S., Bhandarkar S.D. Ainapuri S.S. Pharmacology and Pharmaco-

therapeutics Chapter 38. 16th ed. Mumbai; Popular Prakashana Publications;

1999. p. 580.

PANDUROGA

1) Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 16 Shloka 2. Yadavaji

Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan;

2004.p.526.

2) Radhakant Deva Bahaddur, Shabdakalpadruma, 3rd ed. Varanasi : Chaukhamba

Orientalia; 1967.p.104.

3) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 3. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.517.

Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 11. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.488.

4) Sushruta, Sushruta Samhita Uttaratantra, Chapter 44 Shloka 4. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.285.

Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 2. 28st ed. Varanasi :

Chaukhamba Orientalia; 1998. p.221.

5) Sushruta, Sushruta Samhita Sutrasthana Chapter 14 Shloka 44. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.56.

6) Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 4. 22nd ed. Varanasi:

Chaukhamba Orientalia; 1996.p.443.

7) Sushruta, Sushruta Samhita Sutrasthana Chapter 14 Shloka 4. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.48.

8) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 12 Shloka 13. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.194.

9) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.487.

139

10) Agnivesha, Charaka Samhita Sutrasthana Chapter 12 Shloka 11. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.251.

11) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 7-11. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.488.

12) Sushruta, Sushruta Samhita Uttaratantra, Chapter 44 Shloka 3. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.284.

13) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 12 Shloka 1. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.517.

14) Agnivesha, Charaka Samhita Sutrasthana Chapter 23 Shloka 5. 22nd ed. Varanasi:

Chaukhamba Orientalia; 1996.p.436.

15) Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 2. 28st ed. Varanasi :

Chaukhamba Orientalia; 1998. p.245.

Indradev Tripathi Dr, Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar,

Shloka 2, 1st ed. Varanasi : Chaukhamba Orientalia; 1998. p.336.

Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 2. 5st ed.

Varanasi: Chaukhamba Orientalia; 1969. p.100.

16) Sushruta, Sushruta Samhita Nidanasthana Chapter 11 Shloka 17. 13th ed. Varanasi

: Chaukhamba Orientalia; 2002.p.273.

17) Sushruta, Sushruta Samhita Shareerasthana Chapter 2 Shloka 21. 13th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.12.

18) Agnivesha, Charaka Samhita Chikitsasthana Chapter 4 Shloka 27. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.285.

19) Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed.

Varanasi: Chaukhamba Orientalia; 2002.p.71.

20) Sushruta, Sushruta Samhita Nidanasthana Chapter 2 Shloka 14. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.238.

21) Sushruta, Sushruta Samhita Nidanasthana Chapter 8 Shloka 15. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.258.

22) Ibid 16.

23) Sushruta, Sushruta Samhita Nidanasthana Chapter 6 Shloka 15. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.254.

140

24) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 12. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.488.

25) Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 5. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.286.

26) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 8-9. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

27) Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 3. 28st ed. Varanasi :

Chaukhamba Orientalia; 1998. p.225.

Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 3, 5st ed.

Varanasi: Chaukhamba Orientalia; 1969. p.100.

Indradev Tripathi Dr, Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar,

Shloka 3, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.337.

28) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 13-16. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.488-489.

29) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 4-7. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

30) Gangadhara, Chakrapani, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4-6,

Reprint. Varanasi: Chaukhamba Orientalia; 1991.p.2974.

31) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 3. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.486.

32) Sushruta, Sushruta Samhita Uttaratantra Chapter 14 Shloka 4. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.285.

33) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 7. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

34) Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 1, 5st ed.

Varanasi: Chaukhamba Orientalia; 1969. p.98.

Indradev Tripathi Dr, Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar,

Shloka 1, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.336.

Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 1. 28st ed. Varanasi :

Chaukhamba Orientalia; 1998. p.220.

141

35) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 17-18. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.489.

Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 7. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.286.

Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 9-10. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

36) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 19-22. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.489.

Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 8. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.286.

Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 10-11. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

37) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 23-25. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.489.

Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 9. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.287.

Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 11-12. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

38) Madatraya Maharshi, Hareetamuni, Samvadarupa Vaidya Granth, Harita Samhita

Chapter 8 Shloka 10 Edited by Khemraj Shrikrishnadas; Bombay: Swakiya

Venkateshwar Mudranlaya; 1984.p.148.

39) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 26. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.489-490.

Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 10. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.287.

Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 12. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

40) Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 16 Shloka 27-30.

Yadavaji Trikamji acharya, reprinted. Varanasi: Chaukhamba Sanskrit Sansthan;

2004.p.528.

142

41) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 13-15. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.518.

42) Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 9-11. 28st ed. Varanasi :

Chaukhamba Orientalia; 1998. p.229.

Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 8-10, 5st ed.

Varanasi: Chaukhamba Orientalia; 1969. p.101.

Indradev Tripathi Dr. Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar,

Shloka 1-3, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.337.

43) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4-6,9-11. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.487-488.

44) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 1-3. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.517.

45) Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 3. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.284.

46) Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 15. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.290.

47) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 31-33. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.490-491.

Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 12-14. 28st ed. Varanasi :

Chaukhamba Orientalia; 1998. p.230-231.

Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 14-15, 5st ed.

Varanasi: Chaukhamba Orientalia; 1969. p.102.

Indradev Tripathi Dr. Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar,

Shloka 1-5, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.338.

48) Arundutta, Ashtanga Hridaya Chikitsasthana Chapter 16 Shloka 5. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.701.

Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 39-41. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.493.

49) Dalhanacharya, Sushruta Smahita Uttartantra, Chapter 44 Shloka 14. 8th ed.

Varanasi: Chaukhamba Orientalia; 2005.p.730.

143

50) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 55. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.496.

51) Arundutta, Ashtanga Hridaya Chikitsasthana Chapter 16 Shloka 35. Reprinted.

Varanasi: Chaukhamba Orientalia; 2000.p.703.

Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 117. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.504.

52) Ibid 34 &116.

53) Y. T. Acharya, Astanga Sangraha Chikitsasthana Chapter 18 Chapter 11. 11st ed.

Varanasi: Chaukhamba Orientalia; 1996.p.475.

Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 41. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.493.

ANAEMIA

01. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee

Brother’s Medical Publishers; 2000.p.334-342.

02. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher

Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill

Livingstone;2002.p.903.

03. Satuskar R.S., Bhandarkar S.D. Ainapuri S.S. Pharmacology and Pharmaco-

therapeutics Chapter 30. 16th ed. Mumbai; Popular Prakashana Publications;

1999. p.453.

04. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee

Brother’s Medical Publishers; 2000.p.344.

SHAREERA 01. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New

Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.877-878.

02. Ibid. 884-885.

03. Ibid. 898-899.

04. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.711.

05. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed.

Varanasi : Chaukhamba Orientalia; 2002.p.71.

144

06. Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 24 Shloka 35.

Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan;

2004.p.584.

07. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 9. 13th ed. Varanasi

: Chaukhamba Orientalia; 2002.p.70.

08. Agnivesha, Charaka Samhita Chikitsasthana Chapter 15 Shloka 16. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.456.

09. Sushruta, Sushruta Samhita Sutrasthana Chapter 21 Shloka 10. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.89.

10. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 12 Shloka 13. Reprinted.

Varanasi : Chaukhamba Orientalia; 2000.p.194.

11. Sushruta, Sushruta Samhita Shareerasthana Chapter 4 Shloka 13. 13th ed.

Varanasi : Chaukhamba Orientalia; 2002.p.30.

12. Sushruta, Sushruta Samhita Sutrasthana Chapter 21 Shloka 4. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.87.

13. Sushruta, Sushruta Samhita Sutrasthana Chapter 15 Shloka 5. 13th ed. Varanasi :

Chaukhamba Orientalia; 2002.p.56.

14. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.711.

15. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed.

Varanasi : Chaukhamba Orientalia; 2002.p.71.

16. Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 24 Shloka 35.

Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan;

2004.p.584.

17. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New

Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.651.

18. Agnivesha, Charaka Samhita Chikitsasthana Chapter 15 Shloka 16. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.456.

b. Arundutta, Ashtanga Hridaya Shareerasthana Chapter 3 Shloka 8. Reprinted.

Varanasi : Chaukhamba Orientalia; 2000.p.386

145

19. Sushruta, Sushruta Samhita Shareerasthana Chapter 4 Shloka 4. 13th ed. Varanasi

: Chaukhamba Orientalia; 2002.p.28.

20. Ibid.

21. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New

Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.667.

Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher

Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill

Livingstone;2002.p.895.

22. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 4. 22nd ed. Varanasi:

Chaukhamba Orientalia; 1996.p.443.

23. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher

Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill

Livingstone;2002.p.897.

24. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 22. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.447.

25. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 24. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.449.

26. C.C.Chatterjee, Human Physiology, Vol. – I. Chapter 4. Kolkata : Ashutosh

Lithographic Co.; 2004.p.123-124.

DRUG REVIEW 01. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 6 Shloka 164. Reprinted.

Varanasi : Chaukhamba Orientalia; 2000.p.119.

02. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 44-46. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.494.

03. Govind Das, Bhaishajya Ratnawali. Jwarachikitsa Prakarana. 7th ed. Kaviraj

Ambikadutta Shastri Editor. Varanasi; Chaukhamba Orientalia; 1983.p.130.

(Kashi Sanskrit Series, 152).

04. Sushruta, Sushruta Samhita Chikitsasthana Chapter 32 Shloka 26. 13th ed.

Varanasi : Chaukhamba Orientalia; 2002.p.141.

05. Agnivesha, Charaka Samhita Kalpasthana Chapter 7 Shloka 44-46. 22nd ed.

Varanasi: Chaukhamba Orientalia; 1996.p.494.

146

06. Bhavamishra, Bhavaprakasha Poorvakhanda. 5th ed. Varanasi : Chaukhamba

Orientalia; 1969. p.13.

07. Ibid. 17.

08. Ibid. 15.

09. Ibid. 582.

10. Ibid. 34.

11. Ibid. 22.

12. Ibid. 651.

13. Ibid. 232.

14. Ibid. 243.

15. Ibid. 228.

16. Ibid. 222.

17. Ibid. 52.

18. Ibid. 5.

19. Ibid. 10.

20. Ibid. 400.

21. Ibid. 398.

22. Ibid. 797.

23. Ibid. 788.

24. Dr. Nadakarni K. M. Indian Materia Medica. Vol. I 3rd ed. Bombay : Popular

Prakshana; 1976..965.

25. Ibid. 969. 26. Ibid. 1308. 27. Ibid. 333. 28. Ibid. 428. 29. Ibid. 333. 30. Ibid. 475. 31. Ibid. 478. 32. Ibid. 1205. 33. Ibid. 480. 34. Ibid. 116. 35. Ibid. 1015.

147

1

POST GRADUATE STUDIES DEPARTMENT OF PANCHAKARMA

“ Clinical evaluation of Virechana Therapy in the management of Panduroga

- An observational clinical study”

Guide : Dr.P.Shivaramudu M.D.(Ayu.) Co – Guide : Dr.S.H.Doddamani M.D.(Ayu.) P.G.Scholar: Shaila.G.Borannavar 01. Name : Sl.No : 02. Father/Husband’s Name: O.P.D. No.: 03. Age : I.P.D.No. : 04. Sex : Bed No. : 05. Religion : 06. Occupation : 07. Economical Status : 08. Diet Date Of Initiation : 09. Address Date Of Completion:

Telephone No.: 10. Result :

11. Consent : I am fully educated with the disease and treatment; there by I got satisfied whole-

heartedly. I accept for the medicinal trail over me.

Signature of Investigator Signature of Patient

Hindu Muslim Christian Others

Household Student Service Labor Sedentary

Poor Middle class Higher class

Good Responded Moderate Responded Poor Responded Not Responded

Vegetarina Mixed

2

I. HISTORY TAKING:

A. Pradhana Vedana: Avadhi

01. Vaivarya of Prakruta / Pandu / Krishna / Aruna / Peeta / Shukla.

Nakha ( )

Netra ( )

Twak ( )

Vit ( )

Mootra ( )

Sira ( )

02. Shonakshikuta ( )

03. Arohanaayasa ( )

04. Hridrava ( )

05. Dourbalya ( )

06. Shrama ( )

07. Brama ( )

08. Sadana ( )

09. Shirashoola ( )

10. Gatrashoola ( )

11. Shabdaasahishnuta ( )

12. Pindikodvestana ( )

B. Anubandhi Vedana Avadhi Avadhi

Karnaskweda ( ) Jwara ( )

Aruchi ( ) Swasa ( )

Agnimandya ( ) Kasa ( )

Trishna ( ) Hataprabha ( )

Toda ( ) Shishiradweshi ( )

Praseka ( ) Mridbhakshanaapeksha( )

Alasya ( ) Swarakshaya ( )

Tandra ( ) Twak sputana ( )

Alpameda ( )

3

C. Adyathana Vyadhi vrittanta –

a. Mode of Onset :

b. Course : D. Poorva Vyadhi Vrittanta :

* Bleeding disorders – Vividha abhighata / Krimiroga / Arsha / Raktapitta / Raktarbuda.

* Yakrut or Pleeha vikara

* Metabolic and other disordes – Prameha / Rajayakshma / Others

* Pyogenic diseases – Vruna / Arbuda

E. Chikitsa Vrittanta :

* Modern medicine -

* Ayurvedic -

* Surgery (Gastrointestinal) -

* Others -

F. Kulu Vrittanta :

* Hemophilia

* Purpura

* Leukemia

* Others

G. Atura charya : a. Ahara

i. Diet:

ii. Dominent rasa in the food: iii. Dietric habits:

Sudden Gradual Insidious Sub acute

Gradually progressive Persistent Relapsing Receding

Vegetarian Mixed

Madhura Katu Amla Tikta Lavana Kashaya

Samashana Adyashana Anashana Vishamashana

4

b. Vihara

i. Vyayama:

ii. Vyavaya: iii. Manasika Vikara: iv. Vyasana: v. Nidra: H. Gynecological History :

Menstrual Cycle Menarche & Menopause

I. Obstetrics history :

Nature of delivery

Last delivery

Mild Moderate Heavy

Chinta Shoka Bhaya Krodha Others

Madhyapana Tobacco Dhomapana Others

Sound Disturbed Divaswapna

Regular Irregular

Number of days

Inter Menstrual period

Associated of any complaints

Menorrhagia Metrorrhagia Leucorrhoca Dysmenorrhoea Ammenorrhea

Gravida Para

Abortion Miscarriage Still birth

Number of deliveries

Normal Forceps Surgical

5

II. EXAMINATION

01. Samanya Pareeksha:

Shareera Bhara

Ashta Sthana Pareeksha:

02. Vishesha Pareeksha:

SROTO PAREEKSHA

I. Rasavaha: Asraddha / Aruchi / Asyavairasya / Arasajnata / Hrillasa / Gourava /

Tandra / Sangamardajwara / Tama / Pandutva / Shrotorodha / Klaipya / Sada /

Krishnangata / Agninasa / Akaalavali / Akaalapalitya.

II. Raktavaha: Mukhapaka / Akshiroga / Vaivarnya / Agnimandya / Pipasadhikya /

Gurugatrata / Santapa / Dourbalya / Aruchi / Shirashoola / Tiktaamlodhara /

Vidahaannapanasya / Klama / Lavanasyata / Swedadhikya / Kampa / Swarakshaya /

Tandra / Nidradhikya / Tamapravesha / Kandu / Pidaka / Pradara / Others.

C. Others: II. Pranavaha -

III. Udakavaha -

IV. Annavaha -

V. Mamsavaha -

VI. Medovaha -

VII. Asthivaha -

VIII. Majjavaha -

IX. Shukravaha -

X. Purishavaha -

XI. Mootravaha -

XII. Swedavaha -

Nadi

Mala

Mootra

Shabdha

Sparsha

Jihva

Drink

Akruti

6

03. Systemic Examination :

a. Shiras (Head & Neck)

b. Madhyamanga (Uraha pradesh)

c. Cardiovascular system (Hridaya)

d. Respiratory system (Phuppusa)

e. Urinary system (Mutravaha srotas)

f. Digestive system (Annavaha srotas)

g. Nervous system

04. Investigations

Specific :

Hb R.B.C. PCV MCV

MCHC Peripheral Blood Smear

Routine Blood Investigations :

WBC – TC DC

ESR

Urine Routine :

Albumin

Sugar

Microscopic

Others : If necessary.

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05. Dashavidha Pareeksha :

1. Prakritaha : Pravara Madhyama Avara

2. Sara : Pravara Madhyama Avara

3. Satwa : Pravara Madhyama Avara

4. Satmya : Ekarasa Sarva rasa Vyamishra Rooksha Snigdha

5. Samhanana : Susamhata Madhyama samhata Asamhata

6. Pramana : Sama Heena Adhika

7. Ahara Shakti :

Abhyavarana : Pravara Madhyama Avara

Jarana Shakti : Pravara Madhyama Avara

8. Vyayama Shakti ; Pravara Madhyama Avara.

9. Vaya : Bala Yuva Vriddha

10. Vikriti Pareeksha :

a) Nidana Ahara Vihara Manasika

Kshara Divaswapna Kama Amla Ativyayama Chinta Lavana Ativyavaya Bhaya Atyushna Vegadharana Krodha Atiteekshna Ritu vaishamya Shoka Viruddha Prati karma Asatmya Masha Nishpava Tilataila Pinyaka Madya Mrit

8

b) Purvapupa

Hrit spandana Gatrasada

Twak rookshata Mridbhakshaneccha

Aruchi Akshikotashotha

Swedaabhava Avipaka

Agnimandhya Peeta mootrata

Shrama Peeta purisha

Sthivana

c) Rupa

Sl Vataja Pittaja Kaphaja Mridbhakshana janya

1.

Krishna / Aruna varna Rookshata of – Nakha Netra Twacha Vit Mootra Sira

Peetata of – Nakha Netra Twacha Vit Mootra Sira

Swetata of – Nakha Netra Twacha Vit Mootra Sira

Shotha of – Akshikoota Bhroo Ganda pradesha Nabhi Linga Pada

2. Soochivat Vedana Jwara Swetavabhasata Krimikoshta 3. Bhrma Daha Gourava 4. Kampana Trishna Moorcha

5. Parshwashoola Chardi Brama

Mala – Kaphayukta Raktayukta

6. Shirashoola Sweda Shwasa 7. Shopha Amlodgara Alasya 8. Asya Vairasya Dourbalya Shwayatu 9. Anaha Shosha 10 Balakshaya Binna

varchashta

11 Shopa

9

CHIKITSA Virechana Karma

Deepana Pachana: With Trikatu choorna

3- 6 grams two times a day before meals (Half an hour before breakfast and lunch

Snehapana with Dadimadi Ghrita in Arohana vidhi with sukhoshna Jala in abhakta

vastha till samyak snigdha lakshanas are seen.

A. Observation for matra and time of administration of snehadravya.

Day / Time I II III IV V VI VII

Sneha Matra

Pana Kala

Kshudha Pravrutti Kala

Total time taken for digestion

B. Observation for matra and time of administration of snehadravya.

Lakshanas I II III IV V VI VII I

Vatanulomana

Agnideepti

Purisha snigdhata

Asamhata varchas

Twaka snigdha

Anga laghava

Gatra mardava

Snehodwega

Klama

Shaithilya

10

Abhyanga : Abyanga with Moorchita tila taila followed with Ushna jala snana (Mridu sweda)

for 3 days. Virechana Karma with “Vyoshadi Gutika.”

Observation:

Assessment of virechana: Date/Time Dose Anupana Mala

pravritti

Colour App.

Quantity

Vega BP/Pulse Temp/Resp.

Samsarjana Krama:

Samsarjana karma is advised for 3 to 7 days according to shuddhi followed with

placebo administration.

Time / Day Matra Anupana

Vega Prarambha Vega Shamana

Laingiki Vaigiki Antaki Manaki Degree of Virechana

Srotoshudhi

Indriya Prasadana

Shareera Laghuta

Agnideepti

Anamayatwa

Vatanulomana

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RESULT ASSESSMENT

* Subjective Parameters :

Objective Parameters : Hb% Before treatment After Virechana After treatment

Investigators Note : Signature of Co-Guide Signature of Guide

Symptoms before treatment

Symptoms after Virechana Symptoms after treatment

Total RBC Count Before Treatment After Treatment

PCV

MCH

MCHC

Blood smear