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→Vidhi Vimarsha
=== ''Vidhi Vimarsha'' ===
=== ''Vidhi Vimarsha'' ===
==== Pathological factors ====
*''Dosha'': ''Pitta'' dominant three ''dosha, sadhaka'' and ''ranjak pitta, vyana'' and ''samana vata, avalambak'' and ''kledaka kapha''
*''Dhatu'' (vitiated factors): ''Rasa, rakta, mamsa'' and ''meda''
*Status of ''agni/ dhatwagni/bhutagni'': ''Manda'' at ''rasa, rakta, mamsa'' 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
*''Srotasa'' involved :''Rasavaha, Raktavaha''
*Type of ''samprapti'' : ''Avarodha'' and ''kshaya''
*Basic principles of treatment: ''Shodhana'' (mainly ''virechana'') and ''shamana'' (mainly ''pitta shaman'') as per ''dosha'' dominance
==== General considerations ====
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: 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, chatanies etc.
• Madya includes alcoholic beverages as rum, beer, whisky, vodka etc.
• Kshara includes soda used in diet, cold drinks and beverages.
• Ati tikshna ahara includes as excessively spicy,pungent items as Chhole, Chats, Pakode, Panipuri, Chaps, Rajma, spicy vegetables and other dishes.
• Ati ushna includes food articles which are either very hot as tea, coffee etc. or which increase the metabolic activities of the body or also as very hot temperature.
• Mrittika bhakshana is considered as either oral ingestion of mud or use of articles contaminated with mud as unclean hands and fingers or as improperly washed vegetables or eatables.
• Asatmya bhojana may include food items that are not adopted or suited. It may be considered as sudden change of food style or habit or also as junk food used today, as they are not beneficial.
Some scientific studies have proven the role of some of the aharaja factors in the causation of panduroga as tea (considered as ati ushna nidana) has been proved to cause iron deficiency anemia by interfering with the absorption of iron. Similarly madya (alcohols) cause megaloblastic anemia by hampering the folate absorption.
Lifestyle: Excess day time sleep, exercise beyond one’s capacity and at improper time can lead to pandu. Therefore, proper quality sleep and proper exercise are preventive measures for pandu.
Psychological factors: Passion, worry, fear, anger and grief can affect digestion leading to poor nutritional status. Hence blissful state of mind is needed for proper nutrition. Rai and Kar in their observational study showed that worries, fear and grief are major etiological factors for iron deficiency anemia. These factors cause significant reduction of serum and bone marrow, while inhibiting the process of erythropoiesis. The inflammatory mediators such as IL-6, hepcidin are mediators in this pathology originated from grief and fear.
Iatrogenic factors: Improper administration of oleation therapy and panchakarma procedures can lead to pandu.
Pathophysiology:
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 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 type of pathogenesis includes formation of sama dhatu (improperly formed tissues) due to poor digestive and metabolic processes at the abovementioned levels. Therefore, the treatment principle includes correction of this impairment.
Current clinical practices in treatment of ''pandu'' and ''kamala'' ( referred from Chikitsa Pradeep):
Current clinical practices in treatment of ''pandu'' and ''kamala'' ( referred from Chikitsa Pradeep):