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

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

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''Pandu roga'' (resembling with anemia) is characterized by pallor which is associated with different colors according to ''dosha'' involved. Besides ''pandu roga'', this chapter also describes two types of ''kamala'' (jaundice) which are two other associated diseases, caused by predominance of ''pitta dosha'' which causes alteration in normal colors of the body. The chapter describes general etiology, pathogenesis, symptoms etc of ''pandu roga'' (anemia) as well as each of its five types viz. ''vata, pitta, kapha, sannipataja'' and ''mrittika-bhakshana'' (clay eating) ''pandu''. After describing general principle of treatment of ''pandu'' and ''kamala'', detailed treatment of each of the conditions mentioned above along with ''pathya'' (recommended diet) and apathya (prohibited diet) are given.  

''Pandu roga'' (resembling with anemia) is characterized by pallor which is associated with different colors according to [[dosha]] involved. Besides ''pandu roga'', this chapter also describes two types of ''kamala'' (jaundice) which are two other associated diseases, caused by predominance of [[pitta]] [[dosha]] which causes alteration in normal colors of the body. The chapter describes general etiology, pathogenesis, symptoms etc of ''pandu roga'' (anemia) as well as each of its five types viz. [[vata]], [[pitta]], [[kapha]], sannipataja and ''mrittika-bhakshana'' (clay eating) ''pandu''. After describing general principle of treatment of ''pandu'' and ''kamala'', detailed treatment of each of the conditions mentioned above along with ''pathya'' (recommended diet) and apathya (prohibited diet) are given.  

'''Keywords''': ''Pandu roga, kamala, koshthashakhashrita kamala, shakhashrita kamala, panaka, kumbhakamala, haleemaka,'' anemia, jaundice

'''Keywords''': ''Pandu roga, kamala, koshthashakhashrita kamala, shakhashrita kamala, panaka, kumbhakamala, haleemaka,'' anemia, jaundice

After the description of ''grahani dosha'', the chapter on ''pandu roga'' is given, as the causative factors of ''pandu roga'' are quite similar to that of ''grahani dosha''. Probably it is because that the various gastrointestinal problems can also lead to development of ''pandu roga''. The chapter deals with general discoloration of the body such as pallor, yellowish, greenish and whitish discoloration which is seen in skin, eyes, lips, face, nails, urine feces etc.  

After the description of ''grahani dosha'', the chapter on ''pandu roga'' is given, as the causative factors of ''pandu roga'' are quite similar to that of ''grahani dosha''. Probably it is because that the various gastrointestinal problems can also lead to development of ''pandu roga''. The chapter deals with general discoloration of the body such as pallor, yellowish, greenish and whitish discoloration which is seen in skin, eyes, lips, face, nails, urine feces etc.  

''Kamala'' (jaundice) and ''haleemaka'' (severe obstructive jaundice) have also been included in this chapter as they are also characterized by the discoloration and may relate to ''pandu roga''. ''Kamala'' is of two types, ''swatantra'' (primary) and ''partantra'' (secondary). The etiological factors of ''primary kamala'' are described later. Secondary ''kamala'' develops in chronic phase of ''pandu'' in which vitiated ''pitta'' is seated in ''rasa dhatu'' and in ''kamala, pitta'' goes deeper in ''rakta dhatu'' and continues to go deeper in ''mamsa'' and ''medha dhatu'', then it is called ''haleemaka'' and ''kumbha kamala'' respectively.  

''Kamala'' (jaundice) and ''haleemaka'' (severe obstructive jaundice) have also been included in this chapter as they are also characterized by the discoloration and may relate to ''pandu roga''. ''Kamala'' is of two types, ''swatantra'' (primary) and ''partantra'' (secondary). The etiological factors of ''primary kamala'' are described later. Secondary ''kamala'' develops in chronic phase of ''pandu'' in which vitiated [[pitta]] is seated in [[rasa dhatu]] and in kamala, [[pitta]] goes deeper in [[rakta dhatu]] and continues to go deeper in [[mamsa dhatu]] and [[medha dhatu]], then it is called ''haleemaka'' and ''kumbha kamala'' respectively.  

''Kamala'' is of two types in repect to location, ''shakhshrita kamala'' located in body tissues in the form of obstructed ''pitta'' and ''koshthashrita kamala'', localized to gut and can be easily removed by purgation while ''shakhashrita kamala'' needs to be brought to gut for removal.

''Kamala'' is of two types in repect to location, ''shakhshrita kamala'' located in body tissues in the form of obstructed [[pitta]] and ''koshthashrita kamala'', localized to gut and can be easily removed by purgation while ''shakhashrita kamala'' needs to be brought to gut for removal.

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== Sanskrit Text, Transliteration and English Translation ==

== Sanskrit Text, Transliteration and English Translation ==

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''Pandu roga'' is classified into five types as ''vatika, paittika, kaphaja, tridoshaja'' and ''mrittika bhakshhana janya pandu'' [3]

Pandu roga is classified into five types as vatika, paittika, [[kapha]]ja, tri[[dosha]]ja and mrittika bhakshhana janya pandu [3]

=== Pathogenesis of ''pandu'' ===

=== Pathogenesis of pandu ===

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Aggravated ''pitta'' predominant ''dosha'' vitiates the ''dhatu''. This vitiation of ''dhatus'' cause sluggishnesss (''shithilata'') and heaviness (''gaurava'') in the ''dhatu'' resulting in diminution of complexion (''varna''), strength (''bala''), unctuousness (''sneha'') and the qualities of ''ojas''. Thus, the person develops diminished blood (''rakta'') and the fatty tissue (''medas'') and absence of the vitality of all the tissues (''nihsara'') decreases functional status of sense organs (''sithilendriyah'') and discoloration of the body. ''Hetu'' (etiological factors and pathogenesis) and the sign and symptoms of the disease will be explained hereafter [4-6]

Aggravated [[pitta]] predominant [[dosha]] vitiates the [[dhatu]]. This vitiation of [[dhatu]] cause sluggishnesss (''shithilata'') and heaviness (''gaurava'') in the [[dhatu]] resulting in diminution of complexion (''varna''), strength (''bala''), unctuousness (''sneha'') and the qualities of [[ojas]]. Thus, the person develops diminished blood (''rakta'') and the fatty tissue ([[meda dhatu]]) and absence of the vitality of all the tissues (''nihsara'') decreases functional status of sense organs (''sithilendriyah'') and discoloration of the body. [[Hetu]] (etiological factors and pathogenesis) and the sign and symptoms of the disease will be explained hereafter [4-6]

=== General etio-pathogenesis of ''pandu'' ===

=== General etio-pathogenesis of ''pandu'' ===

*Affliction of mind with passion, worry, fear, anger, grief

*Affliction of mind with passion, worry, fear, anger, grief

Indulgence in the above factors aggravates ''pitta'' seated in the cardiac region and then this ''pitta'' is forcefully propelled by the ''vata'' into the ten ''dhamanis'' (attached to the heart) and further into the whole body. There, it gets located in between the ''tvacha'' (skin) and the ''mamsa'' (flesh) and additionally vitiates the ''kapha, vata, rakta, tvacha'' and ''mamsa'' resulting in the development of various discolorations in the body like ''pandu'' (pale), ''haridra'' (yellow),and ''harita'' (green). This is called as ''pandu roga'' [7-11½]

Indulgence in the above factors aggravates [[pitta]] seated in the cardiac region and then this [[pitta]] is forcefully propelled by the [[vata]] into the ten ''dhamanis'' (attached to the heart) and further into the whole body. There, it gets located in between the ''tvacha'' (skin) and the [[mamsa dhatu]] (flesh) and additionally vitiates the [[kapha]], [[vata]], [[rakta]], tvacha and [[mamsa dhatu]] resulting in the development of various discolorations in the body like ''pandu'' (pale), ''haridra'' (yellow),and ''harita'' (green). This is called as ''pandu roga'' [7-11½]

=== Premonitory symptoms ===

=== Premonitory symptoms ===

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Indulging in ''vata'' increasing diet and regimens aggravates ''vata'' leading to ''vatika pandu roga''. The skin of the patient becomes blackish dawn colored and ununctuous. Its other symptoms are malaise, ache, pricking pain, tremor, pain in both the sides of the chest, headache; dried feces, distaste in the mouth; swelling, gaseous distention of the abdomen and weakness [17-18]

Indulging in [[vata]] increasing diet and regimens aggravates [[vata]] leading to ''vatika pandu roga''. The skin of the patient becomes blackish dawn colored and ununctuous. Its other symptoms are malaise, ache, pricking pain, tremor, pain in both the sides of the chest, headache; dried feces, distaste in the mouth; swelling, gaseous distention of the abdomen and weakness [17-18]

=== ''Paittika pandu'' ===

=== ''Paittika pandu'' ===

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''Pitta'' gets aggravated by indulging in ''pitta'' vitiating ''nidanas'' (diet and regimens) which by involving the blood etc. causes ''pittaja pandu''. Its symptoms are, change in complexion to yellowish/greenish, fever, burning sensation; morbid thirst and fainting; excessive perspiration and longing for cold things and environment. The person does not relish food, develops pungent taste, disfavors hot and sour things; gets sour eructations associated with burning sensation due to impaired digestion of food; emits foul smell from mouth; the urine and stool become yellow in color, has loose motions and develops weakness and fainting [19-22]

[[Pitta]] gets aggravated by indulging in [[pitta]] vitiating ''nidanas'' (diet and regimens) which by involving the blood etc. causes [[pitta]]ja pandu. Its symptoms are, change in complexion to yellowish/greenish, fever, burning sensation; morbid thirst and fainting; excessive perspiration and longing for cold things and environment. The person does not relish food, develops pungent taste, disfavors hot and sour things; gets sour eructations associated with burning sensation due to impaired digestion of food; emits foul smell from mouth; the urine and stool become yellow in color, has loose motions and develops weakness and fainting [19-22]

=== ''Kaphaja pandu'' ===

=== [[Kapha]]ja pandu ===

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Aggravated ''kapha'' by indulging in ''kapha'' increasing diet and regimen gives rise to ''kaphaja pandu roga'' through the pathogenesis described earlier. The sign and symptom of ''kaphaja pandu'' are heaviness, drowsiness, vomiting, whitish complexion, salivation, horripilation, prostration, fainting, giddiness, mental fatigue, dyspnea, cough, laziness, anorexia, obstruction in speech and voice, whitish coloration of the eyes, urine and feces; longing for pungent, ununctuous and hot things; and develops edema and sweet taste in the mouth [23-25]

Aggravated [[kapha]] by indulging in [[kapha]] increasing diet and regimen gives rise to [[kapha]]ja pandu roga through the pathogenesis described earlier. The sign and symptoms of [[kapha]]ja pandu are heaviness, drowsiness, vomiting, whitish complexion, salivation, horripilation, prostration, fainting, giddiness, mental fatigue, dyspnea, cough, laziness, anorexia, obstruction in speech and voice, whitish coloration of the eyes, urine and feces; longing for pungent, ununctuous and hot things; and develops edema and sweet taste in the mouth [23-25]

=== ''Tridoshaja pandu'' ===

=== ''Tridoshaja pandu'' ===

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Indulging in the etiological factors of all the three types of ''pandu'' leads to aggravation of the three ''dosha'' resulting in ''tridoshaja pandu'' with the features of all the three types of ''pandu roga''. This type of ''pandu'' causes much distress to the patient [26]

Indulging in the etiological factors of all the three types of ''pandu'' leads to aggravation of the three [[dosha]] resulting in ''tridoshaja pandu'' with the features of all the three types of ''pandu roga''. This type of ''pandu'' causes much distress to the patient [26]

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

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

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Person indulging in the habitual consumption of clay (''mrittika'') gets dośhā aggravated according to the taste of mud viz. astringent mud aggravates ''vata'', saline and alkaline mud aggravates ''pitta'' and sweet mud aggravates ''kapha dosha''. The clay further because of its ununctuousness causes dryness in the ''rasa'' (nutrients of the digested food). The clay due to its undigestable nature fills and blocks the channels of circulation leading to decrease in the sharpness of the senses, luster, energy and ''ojas'' (vital essence of the tissues). This quickly manifesting ''pandu'' results in the loss of strength, complexion and digestive power. Its clinical features are edema of the cheeks, peri orbital edema and edema on the eyebrows area, feet, umbilical region and the pudendum; infestation of worms in the ''koshtha'' (gastrointestinal tract) and loose motions, the stool associated with blood and mucus [27-30]

Person indulging in the habitual consumption of clay (''mrittika'') gets dośhā aggravated according to the taste of mud viz. astringent mud aggravates [[vata]], saline and alkaline mud aggravates [[pitta]] and sweet mud aggravates [[kapha]] [[dosha]]. The clay further because of its ununctuousness causes dryness in the ''rasa'' (nutrients of the digested food). The clay due to its undigestable nature fills and blocks the channels of circulation leading to decrease in the sharpness of the senses, luster, energy and [[ojas]] (vital essence of the tissues). This quickly manifesting ''pandu'' results in the loss of strength, complexion and digestive power. Its clinical features are edema of the cheeks, peri orbital edema and edema on the eyebrows area, feet, umbilical region and the pudendum; infestation of worms in the ''koshtha'' (gastrointestinal tract) and loose motions, the stool associated with blood and mucus [27-30]

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

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

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If a patient of ''pandu roga'' excessively follows pitta vitiating diet and regimen, the ''pitta'' so aggravated by involving the ''rakta'' and the ''mamsa'' causes ''kamala''. Its clinical features are the eyes, skin, nails and face of the patient become exceedingly yellow; stool and urine become reddish-yellow in color; complexion develops a color similar to that of a frog (found in rainy season); the senses get impaired; has burning sensation, indigestion, weakness, prostration and anorexia. This ''kamala'' is caused by excess of ''pitta'' is known as ''koshthashakhashrita'' [34-36]

If a patient of ''pandu roga'' excessively follows [[pitta]] vitiating diet and regimen, the [[pitta]] so aggravated by involving the [[rakta]] and the [[mamsa dhatu]] causes ''kamala''. Its clinical features are the eyes, skin, nails and face of the patient become exceedingly yellow; stool and urine become reddish-yellow in color; complexion develops a color similar to that of a frog (found in rainy season); the senses get impaired; has burning sensation, indigestion, weakness, prostration and anorexia. This ''kamala'' is caused by excess of [[pitta]] is known as ''koshthashakhashrita'' [34-36]

=== ''Kumbha kamala'' ===

=== ''Kumbha kamala'' ===

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If the stool and urine of the patient (of ''kamala'') become black and yellow; develops excessive edema; eyes and face becomes red colored; vomit, stool and urine are mixed with blood; the patient feels like going in darkness; has burning sensation, anorexia, morbid thirst, constipation, drowsiness and fainting; and the person looses his ''agni'' and consciousness; such patient may succumb to death quickly [37-38½]

If the stool and urine of the patient (of ''kamala'') become black and yellow; develops excessive edema; eyes and face becomes red colored; vomit, stool and urine are mixed with blood; the patient feels like going in darkness; has burning sensation, anorexia, morbid thirst, constipation, drowsiness and fainting; and the person looses his [[agni]] and consciousness; such patient may succumb to death quickly [37-38½]

=== Principles of treatment ===

=== Principles of treatment ===