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Pandu Chikitsa (view source)

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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 dhatu]] 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 [[meda 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.

</div>

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== Sanskrit Text, Transliteration and English Translation ==

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''Shunthi, pippali, maricha, haritaki, bibhitaki, amalaki, musta, vidanga, chavya, chitraka,'' bark of ''daruharidra, makshika'' (copper pyrite), ''pippalimoola'' and ''devadaru'' in the quantity of two ''pala'' each should be made to powders separately.

−

''Mandura bhasma'' which is dark in color like collyrium, should be cooked by adding eight times of cow’s urine and the powders of the above drugs should be mixed to this. ''Vatakas'' (large sized pills) of the size of ''udumbara'' should be made out of this combination. This should be taken by the patient in the appropriate doses according to his ''agni'' (power of digestion and metabolism) along with butter milk. The patient should take wholesome food after its digestion. These pills named as ''mandura vataka'' are the life givers for the patients of ''pandu''. It also cures ''kushtha, ajeerna'' (indigestion), ''sotha'' (edema), ''urustambha'' (stiffening of the thighs), disease caused by aggravation of the ''kapha, arsha'' (hemorrhoids), ''kamala'' (jaundice), ''meha'' (polyuria) and ''pleeha'' (splenic diseases).

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''Mandura bhasma'' which is dark in color like collyrium, should be cooked by adding eight times of cow’s urine and the powders of the above drugs should be mixed to this. ''Vatakas'' (large sized pills) of the size of ''udumbara'' should be made out of this combination. This should be taken by the patient in the appropriate doses according to his [[agni]] (power of digestion and metabolism) along with butter milk. The patient should take wholesome food after its digestion. These pills named as ''mandura vataka'' are the life givers for the patients of ''pandu''. It also cures ''kushtha, ajeerna'' (indigestion), ''sotha'' (edema), ''urustambha'' (stiffening of the thighs), disease caused by aggravation of the [[kapha]], arsha'' (hemorrhoids), ''kamala'' (jaundice), ''meha'' (polyuria) and ''pleeha'' (splenic diseases).

Thus ends the description of two types of ''mandura vataka''.[72-77]

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</div></div>

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''Beejaka'' taken in the amount of sixteen ''pala'', twenty ''pala'' of ''triphala,'' five pala of ''draksha'' and seven ''pala'' of ''laksha'' are added to one ''drona'' of water and boiled till one fourth of water remains. Water should then be taken out by straining. One ''tula'' of sugar, one ''pala'' of honey and one ''pala'' powder of each of the ''shunthi, pippali, maricha, vyaghranakha, kramuka, elavaluka, madhuka'' and ''kushtha'' are added to the above made decoction and the potion be stored in a jar smeared with ghee kept inside a barley heap for ten nights during summer and for twenty nights in winter. Intake of this potion cures ''grahani, pandu, arsha, sotha, gulma, mutra krichha'' (dysuria), ''ashmari'' (stones in the urinary tract), ''meha, kamala'' and diseases caused by all the three ~~''doshas''~~. This is called ''beejaka arishta'' and it was propounded by Atreya.

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''Beejaka'' taken in the amount of sixteen ''pala'', twenty ''pala'' of ''triphala,'' five pala of ''draksha'' and seven ''pala'' of ''laksha'' are added to one ''drona'' of water and boiled till one fourth of water remains. Water should then be taken out by straining. One ''tula'' of sugar, one ''pala'' of honey and one ''pala'' powder of each of the ''shunthi, pippali, maricha, vyaghranakha, kramuka, elavaluka, madhuka'' and ''kushtha'' are added to the above made decoction and the potion be stored in a jar smeared with ghee kept inside a barley heap for ten nights during summer and for twenty nights in winter. Intake of this potion cures ''grahani, pandu, arsha, sotha, gulma, mutra krichha'' (dysuria), ''ashmari'' (stones in the urinary tract), ''meha, kamala'' and diseases caused by all the three [[dosha]]. This is called ''beejaka arishta'' and it was propounded by Atreya.

Thus, ends the description of ''beejaka arishta'' [106-110]

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Water boiled with the drugs belonging to ''sthiradi'' group is useful for drinking and the preparation of foods for ''pandu rogi''; while the patient of ''kamala'' should use the juice of ''draksha'' and ''amalaki rasa'' [114-115]

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=== Principles of treatment according to ''dosha'' ===

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=== Principles of treatment according to [[dosha]] ===

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</div></div>

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The above mentioned drugs are described for the cure of ''pandu roga'' by the great sage (Punarvasu Atreya). The physician should make suitable changes (combinations and permutations) in the above depending upon the strength of the ''dosha'' in the patient.

+

The above mentioned drugs are described for the cure of ''pandu roga'' by the great sage (Punarvasu Atreya). The physician should make suitable changes (combinations and permutations) in the above depending upon the strength of the [[dosha]] in the patient.

−

The therapy should be dominated by unctuous drugs (oil, ghee etc) for ''vatika'' type of ''pandu''; by bitter and cooling drugs for ''paittika'' type and by pungent, bitter and hot drugs for ~~''kaphaja''~~ type of ''pandu'' [115-117]

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The therapy should be dominated by unctuous drugs (oil, ghee etc) for ''vatika'' type of ''pandu''; by bitter and cooling drugs for ''paittika'' type and by pungent, bitter and hot drugs for [[kapha]]ja type of ''pandu'' [115-117]

=== Treatment of ''mrittika bhakshanajanya pandu'' ===

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</div></div>

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Different types of treatment should be given to the patient suffering from ''mrittika bhakshana janya pandu'', according to the different types of ''dosha'' aggravated. However, due to the specific type of etiological factor involved (clay eating), this type of ''pandu'' needs special type of treatment [123-124]

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Different types of treatment should be given to the patient suffering from ''mrittika bhakshana janya pandu'', according to the different types of [[dosha]] aggravated. However, due to the specific type of etiological factor involved (clay eating), this type of ''pandu'' needs special type of treatment [123-124]

=== ''Shakhashrita kamala'' (''kamala'' in body tissue with obstructive pathology) ===

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</div></div>

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A patient of ''kamala'' if passes stools of the color of sesame paste (''tila pishta nibhama''), then it denotes obstruction in the passage of ''pitta'' by the ''kapha''. Therefore, the ''pitta'' of such patient should be won by administration of drugs which also eliminate ''kapha''.

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A patient of ''kamala'' if passes stools of the color of sesame paste (''tila pishta nibhama''), then it denotes obstruction in the passage of [[pitta]] by the [[kapha]]. Therefore, the [[pitta]] of such patient should be won by administration of drugs which also eliminate [[kapha]].

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The excess usage of ununctuous, cold and sweet ingredients; excessive exercise; suppression of the natural urges leads to the the aggravation of ''vata'' infilterated with ''kapha'' and the displacement of ''pitta'' from its site, resulting in the development of the following features:

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The excess usage of ununctuous, cold and sweet ingredients; excessive exercise; suppression of the natural urges leads to the the aggravation of [[vata]] infilterated with [[kapha]] and the displacement of [[pitta]] from its site, resulting in the development of the following features:

−

The eyes, skin and urine of the patient become yellow while his stools become white in color. Additionally, the patients suffer from ''atopa'' (tympanitis), ''vishtambha'' (constipation associated with flatulence),and heaviness in the cardiac region, due to the displacement of ''pitta'' in the peripheral tissues (''shakha''), there is diminution in the flow of ''pitta'' (to the gastrointestinal tract) resulting in the gradual development of weakness, ''agnimandya'' (low digestion), ''parshva'' (pain in the sides of chest), ''hikka'' (hiccups), ''shvasa'' (dyspnea), ''aruchi'' (anorexia) and ''jwara'' [124-128]

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The eyes, skin and urine of the patient become yellow while his stools become white in color. Additionally, the patients suffer from ''atopa'' (tympanitis), ''vishtambha'' (constipation associated with flatulence),and heaviness in the cardiac region, due to the displacement of [[pitta]] in the peripheral tissues (''shakha''), there is diminution in the flow of [[pitta]] (to the gastrointestinal tract) resulting in the gradual development of weakness, ''agnimandya'' (low digestion), ''parshva'' (pain in the sides of chest), ''hikka'' (hiccups), ''shvasa'' (dyspnea), ''aruchi'' (anorexia) and ''jwara'' [124-128]

=== Treatment of ''shakhashriat kamala'' ===

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</div></div>

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The patient suffering from from ''shakhashrita kamala'' should be given food along with the soup of the meat of peacock, ''tittira'' (partridge), ''daksha'' (rooster) sizzled with ununctuous, sour and pungent articles; and vegetable soups of dry ''mulaka'' (radish) and ''kulattha''. The patient should also be given the juice of ''matulunga'' mixed with honey, ''pippali, maricha'' and ''shunthi'' for bringing the ''pitta'' to its own course [128-130]

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The patient suffering from from ''shakhashrita kamala'' should be given food along with the soup of the meat of peacock, ''tittira'' (partridge), ''daksha'' (rooster) sizzled with ununctuous, sour and pungent articles; and vegetable soups of dry ''mulaka'' (radish) and ''kulattha''. The patient should also be given the juice of ''matulunga'' mixed with honey, ''pippali, maricha'' and ''shunthi'' for bringing the [[pitta]] to its own course [128-130]

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</div></div>

−

''Katu'' (pungent), ''teekshna'' (sharp), ''ushna'' (hot), ''lavana'' (saline) and extremely ''amla'' (sour) drugs should be continued till the stool of the patient acquires the color of ''pitta'' and the ''vata'' gets alleviated. When the ''pitta'' returns to its own habitat, the stool gets colored with ''pitta'' and the patient is relieved of complications, then further, the line of treatment described earlier for the treatment of ''kamala'' (''koshthashrita'') should be used [130-132]

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''Katu'' (pungent), ''teekshna'' (sharp), ''ushna'' (hot), ''lavana'' (saline) and extremely ''amla'' (sour) drugs should be continued till the stool of the patient acquires the color of [[pitta]] and the [[vata]] gets alleviated. When the [[pitta]] returns to its own habitat, the stool gets colored with [[pitta]] and the patient is relieved of complications, then further, the line of treatment described earlier for the treatment of ''kamala'' (''koshthashrita'') should be used [130-132]

=== ''Haleemaka'' (obstructive jaundice) ===

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</div></div>

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If a patient suffering from ''pandu'' develops green, black or yellow color and suffers from diminution of strength and enthusiasm; drowsiness, ''agnimandya'' (low digestion), mild fever, lack of libido (''strisu aharsho''), ''angamarda'' (malaise/ body ache), dyspnea, ''trishna'' (morbid thirst), anorexia and giddiness, the ailment is called ''haleemaka'' and is caused by the aggravation of ''vata'' and ''pitta dosha'' [132-134]

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If a patient suffering from ''pandu'' develops green, black or yellow color and suffers from diminution of strength and enthusiasm; drowsiness, ''agnimandya'' (low digestion), mild fever, lack of libido (''strisu aharsho''), ''angamarda'' (malaise/ body ache), dyspnea, ''trishna'' (morbid thirst), anorexia and giddiness, the ailment is called ''haleemaka'' and is caused by the aggravation of [[vata]] and [[pitta]] [[dosha]] [132-134]

=== Treatment of ''haleemaka'' ===

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After oleation with this oil the patient should take ''trivritta'' mixed with the juice of ''amalaki'' which causes purgation.

−

Thereafter food and drinks which are dominated by sweet taste and are alleviators of ''pitta'' and ''kapha'' should be given.

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Thereafter food and drinks which are dominated by sweet taste and are alleviators of [[pitta]] and [[kapha]] should be given.

−

The patient should take ''drakshaleha'' described earlier (vide verse 100-102 in this chapter in the name of ''dhatryavaleha'') and recipes of medicated ghee prepared by boiling with sweet drugs (vide verse 51-52). The patient should habitually indulge in taking different types of ''yapana basti'' (a type of medicated enema), ''kshara basti'' and ''anuvasana basti'' discussed in [ Cha. Sa. [[Siddhi Sthana]] ]. He should also take different recipes of ''arishta'' prepared from grapes (''draksharishta'') for the promotion of power of digestion. ''Abhaya leha'' described in the treatment of ''kasa'' [Cha. Sa. [[Chikitsa Sthana]] 18/57-62] may also be taken. Alternatively the patient may also take ''pippali, madhuka'' and ''bala'' along with milk depending upon the ~~''doshas''~~ aggravated and the strength of the patient [134-138]

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The patient should take ''drakshaleha'' described earlier (vide verse 100-102 in this chapter in the name of ''dhatryavaleha'') and recipes of medicated ghee prepared by boiling with sweet drugs (vide verse 51-52). The patient should habitually indulge in taking different types of yapana [[basti]] (a type of medicated enema), kshara [[basti]] and anuvasana [[basti]] discussed in [ Cha. Sa. [[Siddhi Sthana]] ]. He should also take different recipes of ''arishta'' prepared from grapes (''draksharishta'') for the promotion of power of digestion. ''Abhaya leha'' described in the treatment of ''kasa'' [Cha. Sa. [[Chikitsa Sthana]] 18/57-62] may also be taken. Alternatively the patient may also take ''pippali, madhuka'' and ''bala'' along with milk depending upon the [[dosha]] aggravated and the strength of the patient [134-138]

=== Summary ===

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== Tattva Vimarsha (Fundamental Principles) ==

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*The important pathological factors in ''pandu'' are aggravated three ''dosha'' with dominant ''pitta'' leading to slow metabolism at level of blood (''rakta''), the fatty tissue ~~(''medas''~~) ~~''dhatu''~~ and ''ojas'' qualities (affecting the vitality).

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*The important pathological factors in ''pandu'' are aggravated three [[dosha]] with dominant [[pitta]] leading to slow metabolism at level of blood ([[rakta dhatu]]), the fatty tissue [[meda dhatu]]) and [[ojas]] qualities (affecting the vitality).

*The dietary factors like alkaline, sour, saline, hot and mutually contradictory foods, unwholesome food, ''nishpava'' (a type of pulses), ''masha, pinyaka'' (oil cake) and ''tila'' oil; lifestyle factors like indulging in day sleep, performing exercise and sex before digestion of the food, disobedience of the seasonal regimens (''ritu vaishamya''), suppression of the natural urges; iatrogenic factors like Improper administration of [[Panchakarma]] measures (''pratikarma vaishamya'') and the psychological factors like affliction of mind with passion, worry, fear, anger, grief are responsible for ''pandu''.

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*Heart and circulatory system are involved in the pathogenesis of ''pandu'' which is presented at the sites of skin and ''mamsa'' (flesh).

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*Heart and circulatory system are involved in the pathogenesis of ''pandu'' which is presented at the sites of skin and [[mamsa dhatu]] (flesh).

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*The specific features are observed as per the ''dosha'' dominance in pathogenesis.

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*The specific features are observed as per the [[dosha]] dominance in pathogenesis.

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*Person indulging in the habitual consumption of clay (''mrittika'') gets ''dosha'' aggravated according to the taste of mud viz. astringent mud aggravates ''vata'', saline and alkaline mud aggravates ''pitta'' and sweet mud aggravates ''kapha dosha''. These factors cause ''pandu'' by affecting the ''dhatu'' and ''ojas''.

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*Person indulging in the habitual consumption of clay (''mrittika'') gets [[dosha]] aggravated according to the taste of mud viz. astringent mud aggravates [[vata]], saline and alkaline mud aggravates [[pitta]] and sweet mud aggravates [[kapha]] [[dosha]]. These factors cause ''pandu'' by affecting the [[dhatu]] and [[ojas]].

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*Chronic ''pandu roga'' is incurable. The prognosis depends upon involvement of ''dhatu'' and its intensity.

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*Chronic ''pandu roga'' is incurable. The prognosis depends upon involvement of [[dhatu] and its intensity.

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*If a patient of ''pandu roga'' excessively consumes pitta vitiating diet and regimen, the aggravated ''pitta'' causes ''kamala'' by involving the ''rakta'' and the ''mamsa''.

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*If a patient of ''pandu roga'' excessively consumes [[pitta]] vitiating diet and regimen, the aggravated [[pitta]] causes ''kamala'' by involving the [[rakta]] and the [[mamsa dhatu]].

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*First principle of management of ''pandu'' is administration of internal oleation (''snehana'') followed by strong (''teekshna'') emetic and purgation therapies for cleansing of the body (''shodhana''). In patients of ''kamala'', mild purgation therapy with bitter drugs is advised.

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*First principle of management of ''pandu'' is administration of internal oleation ([[snehana]]) followed by strong (''teekshna'') emetic and purgation therapies for cleansing of the body (''shodhana''). In patients of ''kamala'', mild purgation therapy with bitter drugs is advised.

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*''Kamala'' is of two types: ''Koshtha-shaksha shrita'' and ''shakhashrita''. In ''koshtha-shakhashrita kamala'' there is excess increase in ''pitta''.

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*''Kamala'' is of two types: ''Koshtha-shaksha shrita'' and ''shakhashrita''. In ''koshtha-shakhashrita kamala'' there is excess increase in [[pitta]].

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*In ''shakhashrita kamala'', ''pitta'' is obstructed by ''kapha'' and improperly circulated by ''vata''. Therefore the treatment principles differ in both.

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*In ''shakhashrita kamala'', [[pitta]] is obstructed by [[kapha]] and improperly circulated by [[vata]]. Therefore the treatment principles differ in both.

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*In ''koshtha-shaksha shrita kamala'', mild purgation is administered with bitter drugs with a focus on pacification of ''pitta''.

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*In ''koshtha-shaksha shrita kamala'', mild purgation is administered with bitter drugs with a focus on pacification of[[pitta]].

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*In ''shakhashrita kamala'', principles of management are pacification of ''kapha'', and ''anulomana'' of ''vata'' to derive ''pitta'' to its own natural site. Therefore ''ruksha, amla, katu'' drugs are used in the treatment.

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*In ''shakhashrita kamala'', principles of management are pacification of [[kapha]], and ''anulomana'' of [[vata]] to derive [[pitta]] to its own natural site. Therefore ''ruksha, amla, katu'' drugs are used in the treatment.

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*Suitable changes (combinations and permutations) in the treatment should be prescribed depending upon the strength of the ''dosha'' in the patient. The therapy should be dominated by unctuous drugs (oil, ghee etc) for ''vatika'' type of ''pandu''; by bitter and cooling drugs for ''paittika'' type and by pungent, bitter and hot drugs for ~~''kaphaja''~~ type of ''pandu''.

+

*Suitable changes (combinations and permutations) in the treatment should be prescribed depending upon the strength of the [[dosha]] in the patient. The therapy should be dominated by unctuous drugs (oil, ghee etc) for ''vatika'' type of ''pandu''; by bitter and cooling drugs for ''paittika'' type and by pungent, bitter and hot drugs for [[kapha]]ja type of ''pandu''.

*Strong elimination therapy is advised to remove the swallowed mud from the body after considering the strength of the patient. After the body is cleansed, different types of medicated ghee should be prescribed to the patient for promotion of strength.

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*''Haleemaka'' and is caused by the aggravation of ''vata'' and ''pitta dosha''. Hence the treatment focus on pacification of ''vata'' and ''pitta dosha''.

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*''Haleemaka'' and is caused by the aggravation of [[vata]] and [[pitta]] [[dosha]]. Hence the treatment focus on pacification of [[vata]] and [[pitta]] [[dosha]].

== Vidhi Vimarsha (Applied Inferences ) ==

=== Pathological factors ===

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*''Dosha'': ''Pitta'' dominant three ''dosha, sadhaka'' and ''ranjak pitta, vyana'' and ''samana vata, avalambak'' and ''kledaka kapha''

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*[[Dosha]]: [[Pitta]] dominant three [[dosha]], sadhaka and ranjak [[pitta]], vyana and samana [[vata]], avalambak and kledaka [[kapha]]

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*''Dhatu'' (vitiated factors): ''Rasa, rakta, mamsa'' and ''meda''

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*[[Dhatu]](vitiated factors): [[Rasa dhatu]], [[rakta dhatu]], [[mamsa dhatu]] and [[meda dhatu]]

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*Status of ''agni/ dhatwagni/bhutagni'': ''Manda'' at ''rasa, rakta, mamsa'' and ''meda dhatu'' level

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*Status of [[agni]]/ dhatwagni/bhutagni: ''Manda'' at [[rasa dhatu]], [[rakta dhatu]], [[mamsa dhatu]] and [[meda dhatu]] level

*Origin of disease: Heart and channels, Liver and spleen

*Sites of vitiation: All body

*Sites of clinical presentation: All body specifically skin and subcutaneous tissues

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*~~''Srotasa''~~ involved :''Rasavaha, Raktavaha''

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*Srotas involved :Rasavaha, Raktavaha

*Type of ''samprapti'' : ''Avarodha'' and ''kshaya''

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*Basic principles of treatment: ''Shodhana'' (mainly ''virechana'') and ''shamana'' (mainly ''pitta ~~shaman''~~) as per ''dosha'' dominance

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*Basic principles of treatment: ''Shodhana'' (mainly [[virechana]]) and ''shamana'' (mainly [[pitta]] shamana) as per [[dosha]] dominance

=== General considerations ===

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''Pandu'' can be related with the disorders of improper formation of blood tissue due to vitiation of ''pitta dosha''. ''Pitta dosha'' is considered to be responsible for all digestion, transformation and metabolism processes in the body. Therefore, the disorders like anemia, nutritional deficiency are mainly considered under ''pandu roga''. The disorders which include pathologies of impaired metabolism and formation of plasma, blood, muscles and fat can also be referred under the umbrella of ''pandu roga''. These include thyroid function disorders, hematological disorders like thalessemia, jaundice etc.

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''Pandu'' can be related with the disorders of improper formation of blood tissue due to vitiation of [[pitta]] [[dosha]]. [[Pitta]] [[dosha]] is considered to be responsible for all digestion, transformation and metabolism processes in the body. Therefore, the disorders like anemia, nutritional deficiency are mainly considered under ''pandu roga''. The disorders which include pathologies of impaired metabolism and formation of plasma, blood, muscles and fat can also be referred under the umbrella of ''pandu roga''. These include thyroid function disorders, hematological disorders like thalessemia, jaundice etc.

=== Etiological factors observed in present era ===

==== Diet ====

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The dietary factors that cause vitiation of ''pitta dosha'' and poor nutritional status of ''rakta dhatu'' are enlisted to cause ''pandu''. These include the items having sour, salt, pungent taste, hot potency, alkaline nature, mutually contradictory and unwholesome food. These shall be avoided to prevent ''pandu''.

+

The dietary factors that cause vitiation of [[pitta]] [[dosha]] and poor nutritional status of [[rakta dhatu]] are enlisted to cause ''pandu''. These include the items having sour, salt, pungent taste, hot potency, alkaline nature, mutually contradictory and unwholesome food. These shall be avoided to prevent ''pandu''.

*Food with sour taste (''amla ahara'') includes sour curd, lemons, citric acid, pickles, and food with preservatives as jams, cold drinks, sauces, tamarind etc.

*''Lavana ahara'' may be taken as food with excess salts or with salt added in packaged food or as pickles, chutneys etc.

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==== Pathophysiology ====

[[File:Pandu.png|500px|thumb]]

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The cardinal feature of pandu is appearance of pallor on skin of the patient. Complexion and luster of skin is maintained by ''rasa'' and ''rakta dhatu''. The texture is maintained by ''mamsa dhatu''. Unctuousness is maintained by ''meda dhatu''. These four ~~''dhatus''~~ are important for maintaining the natural appearance of skin. In ''pandu'', the vitiated ''pitta'', due to its hot and sharply acting properties, impairs digestion process at ''rasa, rakta, mamsa'' and ''meda dhatu'' leading to their poor formation. The ''rasa'' transport channels originate in the heart and its vessels. The origin of channels of ''rakta'' is in the liver and spleen. Therefore, symptoms related to cardio-vascular system and hematological system.

+

The cardinal feature of pandu is appearance of pallor on skin of the patient. Complexion and luster of skin is maintained by [[rasa dhatu]] and [[rakta dhatu]]. The texture is maintained by [[mamsa dhatu]]. Unctuousness is maintained by [[meda dhatu]]. These four [[dhatu]] are important for maintaining the natural appearance of skin. In ''pandu'', the vitiated [[pitta]], due to its hot and sharply acting properties, impairs digestion process at [[rasa dhatu]], [[rakta dhatu]], [[mamsa dhatu]] and [[meda dhatu]] leading to their poor formation. The [[rasa dhatu]] transport channels originate in the heart and its vessels. The origin of channels of [[rakta]] is in the liver and spleen. Therefore, symptoms related to cardio-vascular system and hematological system.

−

The sequential nourishment of ''rasa, rakta, mamsa'' and ''meda dhatu'' is impaired leading to poor quality tissues. Thus, overall functions of these systems are disturbed in ''pandu''.

+

The sequential nourishment of [[rasa dhatu]], [[rakta dhatu]], [[mamsa dhatu]] and [[meda dhatu]] is impaired leading to poor quality tissues. Thus, overall functions of these systems are disturbed in ''pandu''.

−

The type of pathogenesis includes formation of ~~''sama~~ dhatu'' (improperly formed tissues) due to poor digestive and metabolic processes at the above mentioned levels. Therefore, the treatment principle includes correction of this impairment.

+

The type of pathogenesis includes formation of same [[dhatu]] (improperly formed tissues) due to poor digestive and metabolic processes at the above mentioned levels. Therefore, the treatment principle includes correction of this impairment.

==== Clinical features and conditions resembling the disease ====

Line 2,045: Line 2,046:

|}

−

The following clinical features are observed in ''pandu''. The involvement of ''dosha, dushya'' and channels are as given in the following table:

+

The following clinical features are observed in ''pandu''. The involvement of [[dosha]], dushya and channels are as given in the following table:

==== Signs ====

Line 2,053: Line 2,054:

! scope="col"| S.No.

! scope="col"| Signs

−

! scope="col"| ''Dosha''

+

! scope="col"| [[Dosha]]

! scope="col"| ''Dushya''

−

! scope="col"| ''~~Srotasa~~''

+

! scope="col"| ''Srotas''

|-

| 1

| ''Dhatushaithilya'' (laxity of tissues)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 2

−

| ~~''Dhatugaurava''~~ (heaviness in tissues)

+

| [[Dhatu]] gaurava (heaviness in tissues)

−

| ''Kapha''

+

| [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 3

| ''Varnakshaya'' (poor complexion)

−

| ''Vata, Pitta''

+

| [[Vata]], [[Pitta]]

−

| ''Rasa, Rakta''

+

| [[Rasa dhatu]],[[Rakta dhatu]]

| ''Rasavaha, Raktavaha''

|-

| 4

| ''Balakshaya'' (poor strength)

−

| ''Vata, Pitta''

+

| [[Vata]],[[Pitta]]

−

| ''Rasa, Rakta''

+

| [[Rasa dhatu]], [[Rakta dhatu]]

| ''Rasavaha, Raktavaha''

|-

| 5

| ''Snehakshaya'' (depletion of unctuousness)

−

| ''Vata, Kapha''

+

| [[Vata]], [[Kapha]]

−

| ''Rakta, Meda''

+

| [[Rakta dhatu]], [[Meda dhatu]]

| ''Raktavaha, Medavaha''

|-

| 6

−

| ~~''Ojagunakshaya~~'' (depletion of vitality)

+

| [[Oja]]gunakshaya'' (depletion of vitality)

−

| ''Vata, Pitta''

+

| [[Vata]], [[Pitta]]

−

| ~~''Saptadhatu''~~

+

| Sapta [[dhatu]]

| ''Saptadhatu vaha''

|-

| 7

| ''Raktalpata'' (poor quality and less blood)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rasa, Rakta''

+

| [[Rasa dhatu]], [[Rakta dhatu]]

| ''Rasavaha, Raktavaha''

|-

| 8

| ''Medalpata'' (poor quality and less fats)

−

| ''Vata, Pitta''

+

| [[Vata]], [[Pitta]]

−

| ''Rakta, Mamsa''

+

| [[Rakta dhatu]], [[Mamsa dhatu]]

| ''Raktavaha, Mamsavaha''

|-

| 9

| ''Nihasarta'' (poor quality tissues)

−

| ~~''Tridosha''~~

+

| Tri[[dosha]]

−

| ~~''Saptadhatu''~~

+

| Sapta[[dhatu]]

| ''Saptadhatu vaha''

|-

| 10

| ''Shithilendriya'' (impairment of senses)

−

| ~~''Tridosha''~~

+

| Tri[[dosha]]

−

| ~~''Saptadhatu''~~

+

| Sapta[[dhatu]]

| ''Rasavaha, Raktavaha''

|-

| 11

| ''Vaivarnya'' (discoloration)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rasa, Rakta, Mamsa''

+

| [[Rasa dhatu]],[[Rakta dhatu]], [[Mamsa dhatu]]

| ''Rasavaha, Raktavaha, Mamsavaha''

|-

| 12

| ''Panduta'' (pallor)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rasa, Rakta, Mamsa''

+

| [[Rasa dhatu]],[[Rakta dhatu]], [[Mamsa dhatu]]

| ''Rasavaha, Raktavaha, Mamsavaha''

|}

Line 2,136: Line 2,137:

! scope="col"| S.No.

! scope="col"| Symptoms

−

! scope="col"| ''Dosha''

+

! scope="col"| [[Dosha]]

! scope="col"| ''Dushya''

−

! scope="col"| ''~~Srotasa~~''

+

! scope="col"| ''Srotas''

|-

| 1

| ''Karnakshweda'' (tinnitus)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rakta''

+

| [[Rakta dhatu]]

| ''Raktavaha''

|-

| 2

| ''Hatanala'' (poor digestion)

−

| ''Kapha, Vata''

+

| [[Kapha]], [[Vata]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 3

| ''Daurbalya'' (weakness)

−

| ''Vata, Pitta''

+

| [[Vata]], [[Pitta]]

−

| ~~''Saptadhatu''~~

+

| Sapta[[dhatu]]

| ''Rasavaha, Raktavaha''

|-

| 4

| ''Sadana'' (bodyache)

−

| ''Vata, Kapha''

+

| [[Vata]], [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 5

| ''Annadwesha'' (anorexia)

−

| ''Kapha''

+

| [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 6

| ''Shrama'' (overworked, fatigue)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rasa''

+

|[[Rasa dhatu]]

| ''Rasavaha''

|-

| 7

| ''Bhrama'' (vertigo)

−

| ''Vata, Pitta''

+

| [[Vata]], [[Pitta]]

−

| ''Majja''

+

| [[Majja dhatu]]

| ''Majjavaha''

|-

| 8

| ''Gatrashoola'' (pain)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rakta, Mamsa''

+

| [[Rakta dhatu]], [[Mamsa dhatu]]

| ''Raktavaha, Mamsavaha''

|-

| 9

| ''Jwara'' (feverishness)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rasa, Sweda''

+

| [[Rasa dhatu]], Sweda

| ''Rasavaha, Swedavaha''

|-

| 10

| ''Shwasa'' (dyspnea)

−

| ''Vata, Kapha''

+

| [[Vata]], [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha, Pranavaha''

|-

| 11

| ''Gaurava'' (heaviness)

−

| ''Kapha''

+

| [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 12

| ''Aruchi'' (aversion to food)

−

| ''Kapha''

+

| [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 13

| ''Mridit iv gatrata'' (kneading pain)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rasa, Rakta, Mamsa''

+

| [[Rasa dhatu]], [[Rakta dhatu]], [[Mamsa dhatu]]

| ''Rasavaha, Raktavaha, Mamsavaha''

|-

| 14

| ''Pidita unmathit gatrata'' (churning, pressing pain)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rasa, Rakta, Mamsa''

+

| [[Rasa dhatu]],[[Rakta dhatu]], [[Mamsa dhatu]]

| ''Rasavaha, Raktavaha, Mamsavaha''

|-

| 15

| ''Akshikutashotha'' (pre-orbital swelling)

−

| ''Kapha''

+

| [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 16

| ''Harita lomata'' (greenish body hair)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 17

| ''Shirnalomata'' (falling body hair)

−

| ''Vata,Pitta''

+

| [[Vata]],[[Pitta]]

−

| ''Asthi''

+

| [[Asthi dhatu]]

| ''Asthivaha''

|-

| 18

| ''Hatprabhatva'' (poor luster)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rakta''

+

| [[Rakta dhatu]]

| ''Raktavaha''

|-

| 19

| ''Kopana'' (irritability)

−

| ''Pitta''

+

| [[Pitta]]

−

| ''Rakta''

+

| [[Rakta dhatu]]

| ''Raktavaha''

|-

| 20

| ''Shishiradwesha'' (disliking cold)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 21

| ''Nindraluta'' (excessive sleepiness)

−

| ''Kapha''

+

| [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 22

| ''Sthivanadhikya'' (excessive sputum)

−

| ''Kapha''

+

| [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|-

| 23

| ''Alpawaka'' (less speaking)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rakta''

+

| [[Rakta dhatu]]

| ''Raktavaha''

|-

| 24

| ''Pindikodweshtanam'' (pain in calf muscles)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rakta, Mamsa''

+

| [[Rakta dhatu]],[[Mamsa dhatu]]

| ''Raktavaha, Mamsavaha''

|-

| 25

| ''Katiurupadaruka Sadana'' (pain in legs, thighs, and the lumbar region)

−

| ''Vata''

+

| [[Vata]]

−

| ''Rasa, Rakta, Mamsa''

+

| [[Rasa dhatu]], [[Rakta dhatu]], [[Mamsa dhatu]]

| ''Rasavaha, Raktavaha, Mamsavaha''

|-

| 26

| ''Arohaneayasa'' (dyspnea on climbing)

−

| ''Vata, Kapha''

+

| [[Vata]], [[Kapha]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

| ''Rasavaha''

|}

Line 2,384: Line 2,385:

|}

−

==== Consequences of ''dhatu kshaya'' ====

+

==== Consequences of [[dhatu]] kshaya ====

{| class="wikitable"

|-

Line 2,393: Line 2,394:

|-

| 1

−

| ''Rasa kshaya''

+

| [[Rasa dhatu]] kshaya

| 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

−

| ''Rakta kshaya''

+

| [[Rakta dhatu]] kshaya

−

| Decrease in quality and volume of blood and further decrease in factors required for formation of ''mamsa''(muscles)

+

| Decrease in quality and volume of blood and further decrease in factors required for formation of [[mamsa dhatu]](muscles)

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

|-

| 3

−

| ''Mamsa kshaya''

+

| [[Mamsa dhatu]] kshaya

−

| Decrease in quality and volume of muscles and further decrease in factors required for formation of ''mamsa''(muscles)

+

| Decrease in quality and volume of muscles and further decrease in factors required for formation of [[mamsa dhatu]](muscles)

| Decrease in muscle proteins, endocrine secretions regulating muscle metabolism

|-

| 4

−

| ''Meda kshaya''

+

| [[Meda dhatu]] kshaya

−

| Decrease in quality and volume of fats and lipids and further decrease in factors required for formation of asthi(bones)

+

| Decrease in quality and volume of fats and lipids and further decrease in factors required for formation of [[asthi dhatu]](bones)

| Decrease in lipids, endocrine secretions regulating lipid metabolism

|}

+

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

{| class="wikitable"

Line 2,468: Line 2,470:

=== ''Kamala'' ===

−

In the second part of the chapter ''pandu, kamala'' is elaborately described. If a person suffering from ''pandu'' follows ''pitta'' provoking diet and lifestyle, he suffers from ''kamala''. This shows ''kamala'' is consequence of ''pandu'' or ''pandu'' is essential causative factor for ''kamala''. This shows the relation of jaundice originated due to hemolytic anemia. In other types of jaundice, this notion is not observed in practice. ''Kamala'' can occur without ''pandu''. (Su.Utt.44/9, A.Hri.Ni.13/15-17)

+

In the second part of the chapter ''pandu, kamala'' is elaborately described. If a person suffering from ''pandu'' follows [[pitta]] provoking diet and lifestyle, he suffers from ''kamala''. This shows ''kamala'' is consequence of ''pandu'' or ''pandu'' is essential causative factor for ''kamala''. This shows the relation of jaundice originated due to hemolytic anemia. In other types of jaundice, this notion is not observed in practice. ''Kamala'' can occur without ''pandu''. (Su.Utt.44/9, A.Hri.Ni.13/15-17)

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

Line 2,474: Line 2,476:

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

−

==== 1. ''Shakhashrita Kamala/Alpa pitta'' (''Dhatu ashrita'') ====

+

==== 1. ''Shakhashrita Kamala/Alpa [[pitta]] (''Dhatu ashrita'') ====

−

The passage of pitta is obstructed by vitiated ''kapha'' and not allowing ''pitta'' to enter ''kostha'', it will cause excess of ''pitta'' in body tissues in ''Shakhasrita Kamala''. This involves the obstructive pathologies at hepatic circulation. As the ''pitta'' cannot enter the gastro-intestinal tract, it leads to clay colored stools. In obstructive jaundice, bilirubin has no access to the intestine and it is the reason for pale stools.

+

The passage of [[pitta]] is obstructed by vitiated [[kapha]] and not allowing [[pitta]] to enter ''kostha'', it will cause excess of [[pitta]] in body tissues in ''Shakhasrita Kamala''. This involves the obstructive pathologies at hepatic circulation. As the [[pitta]] cannot enter the gastro-intestinal tract, it leads to clay colored stools. In obstructive jaundice, bilirubin has no access to the intestine and it is the reason for pale stools.

−

This description of stools being clay colored, but the urine being yellow shows that they were very close in concept to the modern day physiopathology of obstructive jaundice especially hepatocellular ones (wherein due to an inability of the bile to pass into the gastrointestinal tract it circulates into the blood and the conjugated bilirubin being water soluble fraction is filtered and passes out into the urine). Further the description of ''pitta'' being the bi-product of ''rakta'' is also very similar to the fact of bile being produced as a result of Red Blood Cell destruction. The most common cause is gall stones in the common bile duct and pancreatic cancer in the head of pancreas. Also, a group of parasites known as liver flukes can live in common bile duct causing obstructive jaundice. Biliary atresia, cholanjiocarcinoma, pancreatitis, cholestasis of pregnancy and pancreatic pseudocysts are causes for obstruction of bile flow into the duodenum.

+

This description of stools being clay colored, but the urine being yellow shows that they were very close in concept to the modern day physiopathology of obstructive jaundice especially hepatocellular ones (wherein due to an inability of the bile to pass into the gastrointestinal tract it circulates into the blood and the conjugated bilirubin being water soluble fraction is filtered and passes out into the urine). Further the description of [[pitta]] being the bi-product of [[rakta]] is also very similar to the fact of bile being produced as a result of Red Blood Cell destruction. The most common cause is gall stones in the common bile duct and pancreatic cancer in the head of pancreas. Also, a group of parasites known as liver flukes can live in common bile duct causing obstructive jaundice. Biliary atresia, cholanjiocarcinoma, pancreatitis, cholestasis of pregnancy and pancreatic pseudocysts are causes for obstruction of bile flow into the duodenum.

−

==== 2. ''Kostha Shakhashrita Kamala/bahu pitta'' (''Maha Srotasashrita'') ====

+

==== 2. ''Kostha Shakhashrita Kamala/bahu [[pitta]] (''Maha Srotasashrita'') ====

''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.

Line 2,523: Line 2,525:

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

|-

−

|rowspan = "3"|''Vata'' dominant ''pandu''

+

|rowspan = "3"|[[Vata]] dominant ''pandu''

| ''Mahayogaraja samira mixture''

| 120-480 mg

Line 2,539: Line 2,541:

| Milk

|-

−

| rowspan = "2"|''Pitta'' dominant ''pandu''

+

| rowspan = "2"|[[Pitta]] dominant ''pandu''

| ''Tapyadi lauha'' mixture

| 250 - 600 mg

Line 2,550: Line 2,552:

| Honey

|-

−

| ''Kapha'' dominant ''pandu''

+

| [[Kapha]] dominant ''pandu''

| ''Gomutra Haritaki'' mixture

| 600 mg - 3 grams

Line 2,579: Line 2,581:

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

−

*In a study carried out by Shazi L. and Thakar A., ''Amalaki rasayana'' was found effective in management of iron deficiency anemia. However the efficacy was equal in clinical parameters and less in biochemical parameters in comparison to conventional drugs a combination of folic acid and ferrous sulphate. <ref> Shaizi Layeeq, Thakar A.B. Clinical efficacy of Amalaki rasayana in the management of pandu(iron deficiency anemia). Ayu.2015.July-Sep.36(3):290-297. </ref>

+

*In a study carried out by Shazi L. and Thakar A., Amalaki [[rasayana]] was found effective in management of iron deficiency anemia. However the efficacy was equal in clinical parameters and less in biochemical parameters in comparison to conventional drugs a combination of folic acid and ferrous sulphate. <ref> Shaizi Layeeq, Thakar A.B. Clinical efficacy of Amalaki rasayana in the management of pandu(iron deficiency anemia). Ayu.2015.July-Sep.36(3):290-297. </ref>

−

*''Punarnava mandura'' was found effective as ''panduhara'' and ''rasayana'' in patients of geriatric anemia and can counteract most of the pathological manifestations related to ''pandu roga'' in old age (geriatric anemia)<ref>Pandya M.G. Dave A.R. A clinical study of punarnava mandura in the management of pandu roga in old age (geriatric anemia).Ayu,2014 July-Sept; 35(3);252-260. </ref>. In another study on pregnant females, ''punarnava mandura'' and ''dhatri lauha'' are found effective in management of anemia during pregnancy.<ref>Khandelwal D.A, Donga S.B.,Dei L.P. Clinical efficacy of punarnava mandura and dhatri lauha in the management of garbhini pandu (anemia in pregnancy) Ayu,2015 Oct-Dec;36(4); 397-403. </ref>

+

*''Punarnava mandura'' was found effective as ''panduhara'' and [[rasayana]] in patients of geriatric anemia and can counteract most of the pathological manifestations related to ''pandu roga'' in old age (geriatric anemia)<ref>Pandya M.G. Dave A.R. A clinical study of punarnava mandura in the management of pandu roga in old age (geriatric anemia).Ayu,2014 July-Sept; 35(3);252-260. </ref>. In another study on pregnant females, ''punarnava mandura'' and ''dhatri lauha'' are found effective in management of anemia during pregnancy.<ref>Khandelwal D.A, Donga S.B.,Dei L.P. Clinical efficacy of punarnava mandura and dhatri lauha in the management of garbhini pandu (anemia in pregnancy) Ayu,2015 Oct-Dec;36(4); 397-403. </ref>

*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>

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