Pandu Chikitsa: Difference between revisions

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|title=Pandu Chikitsa

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|description=Chikitsa Sthana Chapter 16. Management of Pandu (Anemia and diseases due to blood deficiency)

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<big>'''[[Chikitsa Sthana]] Chapter 16. Management of Pandu (Anemia and diseases due to blood deficiency)</big>'''

{{Infobox

|data5 = [[Sutra Sthana]], [[Nidana Sthana]],  [[Vimana Sthana]],  [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|label6 = Translator and commentator

|label7 = Reviewer  

|data7  = Ojha S.N.

|label8 = Editors

|label9 = Year of publication  

|data9 =  2020

|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.017 10.47468/CSNE.2020.e01.s06.017]

}}

<big>'''Abstract </big>'''

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=== ''Mrittika bhakshana pandu'' ===

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=== Prognosis of ''pandu'' ===

Chronic ''pandu roga'' is incurable. Other symptoms indicating the incurability are appearance of excessive dryness and edema; patient visualizes everything as yellow; passes very hard stool or less amount of stool or passes loose stool associated with mucus and green in color; feels exceedingly prostrated; body becomes excessively white as if be smeared with whiteness; has vomiting, fainting and excessive thirst and when the patient develops excessive whiteness in the body as a result of loss of blood.

=== ''Koshthashakhashraya kamala'' ===

Likewise, ghee prepared with ''keshara, yashtamadhu, pippali, kshara'' (alkali preperation) and ''sadvala'' may be given to the patient suffering from ''mrittika bhakshana janya pandu''.  

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{| class="wikitable"

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| 1

| Decrease in quality tissue that nourish blood or required for formation of blood

| Deficiency in factors required for erythropoietin like vitamin B12, Vitamin K, iron, transferin, ferritin, protein like hemochrome which give red color to blood, electrolyte Na+, K+, Ca++, Mg+, H+, Cl-, albumin, globulins, glucose, amino acid, nucleic acids and lipoprotein, endocrine secretions regulating fluid metabolism   

|-

| 2

| Decrease in volume of whole blood, hematocrit percentage, endocrine secretions regulating blood metabolism   

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| 3

| Decrease in muscle proteins, endocrine secretions regulating muscle metabolism  

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| 4

| Decrease in lipids, endocrine secretions regulating lipid metabolism   

|}

==== List of diseases with features as observed in ''pandu'' ====

{| class="wikitable"

=== ''Kamala'' ===

Yellowish discoloration of sclera, skin, face, nails, and urine associated with constitutional symptoms like anorexia, debility, indigestion, loss of physical strength is called ''Kamala''.

==== Types of ''kamala'' ====

''Bahupitta kamala'' or ''Kostha-shakhasrita kamala'' mostly resembles the pre-hepatic and hepatocellular jaundice. Pre-hepatic jaundice is caused by anything which causes haemolysis. Pre-hepatic cause include severe malaria, certain genetic diseases such as sickle cell anemia, spherocytosis, thalassemia, pyruvate kinase deficiency and glucose 6-phospate dehydrogenase (G6PD) deficiency, which lead to increased destruction of red cells and therefore hemolytic jaundice. Hepato-cellular Jaundice can be caused by acute or chronic hepatitis, hepatotoxicity, cirrhosis, drug induced hepatitis and alcoholic liver disease.

! scope="col"| ''Anupana''

|-

| ''Mahayogaraja samira mixture''

| 120-480 mg

| Milk

|-

| ''Tapyadi lauha'' mixture

| 250 - 600 mg

| Honey

|-

| ''Gomutra Haritaki'' mixture

| 600 mg - 3 grams

==== Evidence based clinical practices ====

*A herbomineral formulation ''Trikatrayadi Lauha'' suspension was observed an effective, well-tolerated, and clinically safe formulation for the management of Iron deficiency anemia in children.<ref>Kumar A, Garai AK. A clinical study on Pandu Roga, iron deficiency anemia, with Trikatrayadi Lauha suspension in children. J [[Ayurveda]] Integr Med 2012;3:215-22.</ref> Khan et.al. observed that the same formulation was observed effective to relieve the signs and symptoms of ''pandu'' in comparison to standard control drug (Fersolate-CM). ''Trikatrayadi lauha'' provided significant improvement on Hbgm%, RBC, PCV, MCV, serum iron, percent transferrin saturation and to decrease TIBC. Therefore ''Trikatrayadi Lauha'' can be used in ''Panduroga'' or IDA as a safe hematinic drug.<ref>Khan Subir kumar, Vyas S.N. Chandola H.M. Efficacy of Trikatrayadi lauha in Pandu roga with reference to iron deficiency anemia. Ayu  2012. Jan-Mar, 33(1):62-67.</ref>  

*Tewari et.al. studied the ethnopharmacological approaches to the therapy of jaundice<ref>Tewari D, Mocan A, Parvanov ED, Sah AN, Nabavi SM, Huminiecki L, Ma ZF, Lee YY, Horba´nczuk JO and Atanasov AG (2017) Ethnopharmacological Approaches for Therapy of Jaundice: Part I. Front. Pharmacol. 8:518. doi: 10.3389/fphar.2017.00518</ref> and highly used plant species from acanthaceae,euphorbiaceae, asteraceae, combretaceae and fabaceae family in the management of jaundice. The team of researchers elaborately studied hystorical perspective of jaundice, its pathophysiology and enlisted 207 herbs used in management of jaundice.<ref>Tewari D, Mocan A, Parvanov ED, Sah AN, Nabavi SM, Huminiecki L, Ma ZF, Lee YY, Horba´nczuk JO and Atanasov AG (2017) Ethnopharmacological Approaches for Therapy of Jaundice: Part II. Highly Used Plant Species from Acanthaceae, Euphorbiaceae, Asteraceae, Combretaceae, and Fabaceae Families. Front. Pharmacol. 8:519. doi: 10.3389/fphar.2017.00519</ref>

Some studies are available on the internet which depict the efficacy of various Ayurvedic drugs having iron (in the form of ''lauha'' and ''mandura'') compounds in the management of ''pandu'':  

The management of ''kamala'' by the drugs stated in the chapter has been found to show good results but the mechanism of their action is still not clear. Practically few studies are available on the net which prove the efficacy of ''Ayurvedic'' compounds in the management of hepatocellular jaundice. <ref>Nirmal kumar and Anil kumar singh. Phalatrikadi kvatha - an ayurvedic hepatoprotective drug. International journal of research in pharmacy and chemistry.2013, 3(3) Available online at www.ijrpc.com</ref>

=== IPGT&RA, Jamnagar ===

#Kumath V. (2006): A Comprehensive Study of Haritaki with Special Reference to the Efficacy of Terminalia chebula Retz. on pandu Roga, MD thesis. P. G. Department. of Dravyaguna, Government. Ujjain, Madhya Pradesh: Autonomous Dhanvantari [[Ayurveda]] College and Hospital; 2006.

The following drugs referred in management of ''pandu'' need to be researched more for providing evidences of its efficacy in anemia and related disorders in comparison to conventional management:  

== References ==