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{{#seo:
|title=Pandu Chikitsa
|titlemode=append
|keywords=Pandu roga, kamala, koshthashakhashrita kamala, shakhashrita kamala, panaka, kumbhakamala, haleemaka, anemia, jaundice, Ayurveda, Indian system of medicine, charak samhita. iron deficiency anaemia, blood deficiency
|description=Chikitsa Sthana Chapter 16. Management of Pandu (Anemia and diseases due to blood deficiency)
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=charak samhita
|type=article
}}
<big>'''[[Chikitsa Sthana]] Chapter 16. Management of Pandu (Anemia and diseases due to blood deficiency)</big>'''
{{Infobox
{{Infobox
|title = Pandu Chikitsa
|title = Pandu Chikitsa
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|header3 =
|data6 = Kar A.C., Rai S., Aladoriya N., [[Yogesh Deole|Deole Y. S.]]
|label7 = Reviewer
|data7 = Ojha S.N.
|label8 = Editors
|data8 = Singh G., Goyal M., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.017 10.47468/CSNE.2020.e01.s06.017]
}}
}}
<big>'''Abstract </big>'''
<p style="text-align:justify;">''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.
<br/>
'''Keywords''': Pandu roga, kamala, koshthashakhashrita kamala, shakhashrita kamala, panaka, kumbhakamala, haleemaka, anemia, jaundice
</p>
== Introduction ==
<div style="text-align:justify;">
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 [[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.
''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>
== Sanskrit Text, Transliteration and English Translation ==
<div class="mw-collapsible mw-collapsed">
अथातः पाण्डुरोगचिकित्सितं व्याख्यास्यामः||१||
अथातः पाण्डुरोगचिकित्सितं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
इति ह स्माह भगवानात्रेयः||२||
<div class="mw-collapsible-content">
athātaḥ pāṇḍurōgacikitsitaṁ vyākhyāsyāmaḥ||1||
athātaḥ pāṇḍurōgacikitsitaṁ vyākhyāsyāmaḥ||1||
iti ha smAha bhagavAnAtreyaH||2||
iti ha smAha bhagavAnAtreyaH||2||
</div></div>
Now, we shall explain the chapter on the treatment of ''pandu roga'' , said Lord Ātreya [1-2]
<div style="text-align:justify;">
Now we shall expound the chapter "Pandu Chikitsa" (Management of Anemia and diseases due to blood deficiency). Thus said Lord Atreya. [1-2]
=== Five types of ''pandu'' ===
<div class="mw-collapsible mw-collapsed">
पाण्डुरोगाः स्मृताः पञ्च वातपित्तकफैस्त्रयः|
पाण्डुरोगाः स्मृताः पञ्च वातपित्तकफैस्त्रयः|
चतुर्थः सन्निपातेन पञ्चमो भक्षणान्मृदः||३||
चतुर्थः सन्निपातेन पञ्चमो भक्षणान्मृदः||३||
<div class="mw-collapsible-content">
pāṇḍurōgāḥ smr̥tāḥ pañca VātaPittaKaphaistrayaḥ|
pāṇḍurōgāḥ smr̥tāḥ pañca VātaPittaKaphaistrayaḥ|
caturthaḥ sannipātēna pañcamō bhakṣaṇānmr̥daḥ||3||
caturthaḥ sannipātēna pañcamō bhakṣaṇānmr̥daḥ||3||
pANDurogAH smRutAH pa~jca vAtapittakaphaistrayaH|
pANDurogAH smRutAH pa~jca vAtapittakaphaistrayaH|
caturthaH sannipAtena pa~jcamo bhakShaNAnmRudaH||3||
caturthaH sannipAtena pa~jcamo bhakShaNAnmRudaH||3||
</div></div>
Pandu roga is classified into five types as vatika, paittika, [[kapha]]ja, tri[[dosha]]ja and mrittika bhakshhana janya pandu [3]
=== Pathogenesis of pandu ===
<div class="mw-collapsible mw-collapsed">
दोषाः पित्तप्रधानास्तु यस्य कुप्यन्ति धातुषु|
दोषाः पित्तप्रधानास्तु यस्य कुप्यन्ति धातुषु|
शैथिल्यं तस्य धातूनां गौरवं चोपजायते||४||
शैथिल्यं तस्य धातूनां गौरवं चोपजायते||४||
ततो वर्णबलस्नेहा ये चान्येऽप्योजसो गुणाः|
ततो वर्णबलस्नेहा ये चान्येऽप्योजसो गुणाः|
व्रजन्ति क्षयमत्यर्थं दोषदूष्यप्रदूषणात्||५||
व्रजन्ति क्षयमत्यर्थं दोषदूष्यप्रदूषणात्||५||
सोऽल्परक्तोऽल्पमेदस्को निःसारः शिथिलेन्द्रियः|
सोऽल्परक्तोऽल्पमेदस्को निःसारः शिथिलेन्द्रियः|
वैवर्ण्यं भजते, तस्य हेतुं शृणु सलक्षणम्||६||
वैवर्ण्यं भजते, तस्य हेतुं शृणु सलक्षणम्||६||
<div class="mw-collapsible-content">
dōṣāḥ Pittapradhānāstu yasya kupyanti Dhātuṣu|
dōṣāḥ Pittapradhānāstu yasya kupyanti Dhātuṣu|
śaithilyaṁ tasya dhātūnāṁ gauravaṁ cōpajāyatē||4||
śaithilyaṁ tasya dhātūnāṁ gauravaṁ cōpajāyatē||4||
tatō varṇabalasnēhā yē cānyē'pyōjasō guṇāḥ|
tatō varṇabalasnēhā yē cānyē'pyōjasō guṇāḥ|
vrajanti kṣayamatyarthaṁ dōṣadūṣyapradūṣaṇāt||5||
vrajanti kṣayamatyarthaṁ dōṣadūṣyapradūṣaṇāt||5||
sō'lparaktō'lpamēdaskō niḥsāraḥ śithilēndriyaḥ|
sō'lparaktō'lpamēdaskō niḥsāraḥ śithilēndriyaḥ|
vaivarṇyaṁ bhajatē, tasya hētuṁ śr̥ṇu salakṣaṇam||6||
vaivarṇyaṁ bhajatē, tasya hētuṁ śr̥ṇu salakṣaṇam||6||
doShAH pittapradhAnAstu yasya kupyanti dhAtuShu|
doShAH pittapradhAnAstu yasya kupyanti dhAtuShu|
shaithilyaM tasya dhAtUnAM gauravaM copajAyate||4||
shaithilyaM tasya dhAtUnAM gauravaM copajAyate||4||
tato varNabalasnehA ye cAnye~apyojaso guNAH|
tato varNabalasnehA ye cAnye~apyojaso guNAH|
vrajanti kShayamatyarthaM doShadUShyapradUShaNAt||5||
vrajanti kShayamatyarthaM doShadUShyapradUShaNAt||5||
so~alparakto~alpamedasko niHsAraH shithilendriyaH|
so~alparakto~alpamedasko niHsAraH shithilendriyaH|
vaivarNyaM bhajate, tasya hetuM shRuNu salakShaNam||6||
vaivarNyaM bhajate, tasya hetuM shRuNu salakShaNam||6||
</div></div>
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'' ===
<div class="mw-collapsible mw-collapsed">
क्षाराम्ललवणात्युष्णविरुद्धासात्म्यभोजनात्|
क्षाराम्ललवणात्युष्णविरुद्धासात्म्यभोजनात्|
निष्पावमाषपिण्याकतिलतैलनिषेवणात्||७||
निष्पावमाषपिण्याकतिलतैलनिषेवणात्||७||
विदग्धेऽन्ने दिवास्वप्नाद्व्यायामान्मैथुनात्तथा|
विदग्धेऽन्ने दिवास्वप्नाद्व्यायामान्मैथुनात्तथा|
प्रतिकर्मर्तुवैषम्याद्वेगानां च विधारणात्||८||
प्रतिकर्मर्तुवैषम्याद्वेगानां च विधारणात्||८||
कामचिन्ताभयक्रोधशोकोपहतचेतसः|
कामचिन्ताभयक्रोधशोकोपहतचेतसः|
समुदीर्णं यदा पित्तं हृदये समवस्थितम्||९||
समुदीर्णं यदा पित्तं हृदये समवस्थितम्||९||
वायुना बलिना क्षिप्तं सम्प्राप्य धमनीर्दश|
वायुना बलिना क्षिप्तं सम्प्राप्य धमनीर्दश|
प्रपन्नं केवलं देहं त्वङ्मांसान्तरमाश्रितम्||१०||
प्रपन्नं केवलं देहं त्वङ्मांसान्तरमाश्रितम्||१०||
प्रदूष्य कफवातासृक्त्वङ्मांसानि करोति तत्|
प्रदूष्य कफवातासृक्त्वङ्मांसानि करोति तत्|
पाण्डुहारिद्रहरितान् वर्णान् बहुविधांस्त्वचि||११||
पाण्डुहारिद्रहरितान् वर्णान् बहुविधांस्त्वचि||११||
स पाण्डुरोग इत्युक्तः ...|१२|
स पाण्डुरोग इत्युक्तः ...|१२|
<div class="mw-collapsible-content">
kṣārāmlalavaṇātyuṣṇaviruddhāsātmyabhōjanāt|
kṣārāmlalavaṇātyuṣṇaviruddhāsātmyabhōjanāt|
niṣpāvamāṣapiṇyākatilatailaniṣēvaṇāt||7||
niṣpāvamāṣapiṇyākatilatailaniṣēvaṇāt||7||
vidagdhē'nnē divāsvapnādvyāyāmānmaithunāttathā|
vidagdhē'nnē divāsvapnādvyāyāmānmaithunāttathā|
pratikarmartuvaiṣamyādvēgānāṁ ca vidhāraṇāt||8||
pratikarmartuvaiṣamyādvēgānāṁ ca vidhāraṇāt||8||
kāmacintābhayakrōdhaśōkōpahatacētasaḥ|
kāmacintābhayakrōdhaśōkōpahatacētasaḥ|
samudīrṇaṁ yadā Pittaṁ hr̥dayē samavasthitam||9||
samudīrṇaṁ yadā Pittaṁ hr̥dayē samavasthitam||9||
vāyunā balinā kṣiptaṁ samprāpya dhamanīrdaśa|
vāyunā balinā kṣiptaṁ samprāpya dhamanīrdaśa|
prapannaṁ kēvalaṁ dēhaṁ tvaṅmāṁsāntaramāśritam||10||
prapannaṁ kēvalaṁ dēhaṁ tvaṅmāṁsāntaramāśritam||10||
pradūṣya Kaphavātāsr̥ktvaṅmāṁsāni karōti tat|
pradūṣya Kaphavātāsr̥ktvaṅmāṁsāni karōti tat|
pāṇḍuhāridraharitān varṇān bahuvidhāṁstvaci||11||
pāṇḍuhāridraharitān varṇān bahuvidhāṁstvaci||11||
kShArAmlalavaNAtyuShNaviruddhAsAtmyabhojanAt|
kShArAmlalavaNAtyuShNaviruddhAsAtmyabhojanAt|
niShpAvamAShapiNyAkatilatailaniShevaNAt||7||
niShpAvamAShapiNyAkatilatailaniShevaNAt||7||
vidagdhe~anne divAsvapnAdvyAyAmAnmaithunAttathA|
vidagdhe~anne divAsvapnAdvyAyAmAnmaithunAttathA|
pratikarmartuvaiShamyAdvegAnAM ca vidhAraNAt||8||
pratikarmartuvaiShamyAdvegAnAM ca vidhAraNAt||8||
kAmacintAbhayakrodhashokopahatacetasaH|
kAmacintAbhayakrodhashokopahatacetasaH|
samudIrNaM yadA pittaM hRudaye samavasthitam||9||
samudIrNaM yadA pittaM hRudaye samavasthitam||9||
vAyunA balinA kShiptaM samprApya dhamanIrdasha|
vAyunA balinA kShiptaM samprApya dhamanIrdasha|
prapannaM kevalaM dehaM tva~gmAMsAntaramAshritam||10||
prapannaM kevalaM dehaM tva~gmAMsAntaramAshritam||10||
pradUShya kaphavAtAsRuktva~gmAMsAni karoti tat|
pradUShya kaphavAtAsRuktva~gmAMsAni karoti tat|
pANDuhAridraharitAn varNAn bahuvidhAMstvaci||11||
pANDuhAridraharitAn varNAn bahuvidhAMstvaci||11||
sa pANDuroga ityuktaH ...|12|
sa pANDuroga ityuktaH ...|12|
</div></div>
Followings are the etiological factors of ''pandu'':
Followings are the etiological factors 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 ===
<div class="mw-collapsible mw-collapsed">
.. तस्य लिङ्गं भविष्यतः|
.. तस्य लिङ्गं भविष्यतः|
हृदयस्पन्दनं रौक्ष्यं स्वेदाभावः श्रमस्तथा||१२||
हृदयस्पन्दनं रौक्ष्यं स्वेदाभावः श्रमस्तथा||१२||
<div class="mw-collapsible-content">
... tasya liṅgaṁ bhaviṣyataḥ|
... tasya liṅgaṁ bhaviṣyataḥ|
hr̥dayaspandanaṁ raukṣyaṁ svēdābhāvaḥ śramastathā||12||
hr̥dayaspandanaṁ raukṣyaṁ svēdābhāvaḥ śramastathā||12||
... tasya li~ggaM bhaviShyataH|
... tasya li~ggaM bhaviShyataH|
hRudayaspandanaM raukShyaM svedAbhAvaH shramastathA||12||
hRudayaspandanaM raukShyaM svedAbhAvaH shramastathA||12||
</div></div>
The premonitory symptoms of the disease are palpitations, ununctuousness, absence of sweating and fatigue [12]
The premonitory symptoms of the disease are palpitations, ununctuousness, absence of sweating and fatigue [12]
=== General symptoms of ''pandu'' ===
<div class="mw-collapsible mw-collapsed">
सम्भूतेऽस्मिन् भवेत् सर्वः कर्णक्ष्वेडी हतानलः|
सम्भूतेऽस्मिन् भवेत् सर्वः कर्णक्ष्वेडी हतानलः|
दुर्बलः सदनोऽन्नद्विट् श्रमभ्रमनिपीडितः||१३||
दुर्बलः सदनोऽन्नद्विट् श्रमभ्रमनिपीडितः||१३||
गात्रशूलज्वरश्वासगौरवारुचिमान्नरः|
गात्रशूलज्वरश्वासगौरवारुचिमान्नरः|
मृदितैरिव गात्रैश्च पीडितोन्मथितैरिव||१४||
मृदितैरिव गात्रैश्च पीडितोन्मथितैरिव||१४||
शूनाक्षिकूटो हरितः शीर्णलोमा हतप्रभः|
शूनाक्षिकूटो हरितः शीर्णलोमा हतप्रभः|
कोपनः शिशिरद्वेषी निद्रालुः ष्ठीवनोऽल्पवाक्||१५||
कोपनः शिशिरद्वेषी निद्रालुः ष्ठीवनोऽल्पवाक्||१५||
पिण्डिकोद्वेष्टकट्यूरुपादरुक्सदनानि च|
पिण्डिकोद्वेष्टकट्यूरुपादरुक्सदनानि च|
भवन्त्यारोहणायासैर्विशेषश्चास्य [१] वक्ष्यते||१६||
भवन्त्यारोहणायासैर्विशेषश्चास्य [१] वक्ष्यते||१६||
<div class="mw-collapsible-content">
sambhūtē'smin bhavēt sarvaḥ karṇakṣvēḍī hatānalaḥ|
sambhūtē'smin bhavēt sarvaḥ karṇakṣvēḍī hatānalaḥ|
durbalaḥ sadanō'nnadviṭ śramabhramanipīḍitaḥ||13||
durbalaḥ sadanō'nnadviṭ śramabhramanipīḍitaḥ||13||
gātraśūlajvaraśvāsagauravārucimānnaraḥ|
gātraśūlajvaraśvāsagauravārucimānnaraḥ|
mr̥ditairiva gātraiśca pīḍitōnmathitairiva||14||
mr̥ditairiva gātraiśca pīḍitōnmathitairiva||14||
śūnākṣikūṭō haritaḥ śīrṇalōmā hataprabhaḥ|
śūnākṣikūṭō haritaḥ śīrṇalōmā hataprabhaḥ|
kōpanaḥ śiśiradvēṣī nidrāluḥ ṣṭhīvanō'lpavāk||15||
kōpanaḥ śiśiradvēṣī nidrāluḥ ṣṭhīvanō'lpavāk||15||
piṇḍikōdvēṣṭakaṭyūrupādaruksadanāni ca|
piṇḍikōdvēṣṭakaṭyūrupādaruksadanāni ca|
bhavantyārōhaṇāyāsairviśēṣaścāsya [1] vakṣyatē||16||
bhavantyārōhaṇāyāsairviśēṣaścāsya [1] vakṣyatē||16||
sambhUte~asmin bhavet sarvaH karNakShveDI hatAnalaH|
sambhUte~asmin bhavet sarvaH karNakShveDI hatAnalaH|
durbalaH sadano~annadviT shramabhramanipIDitaH||13||
durbalaH sadano~annadviT shramabhramanipIDitaH||13||
gAtrashUlajvarashvAsagauravArucimAnnaraH|
gAtrashUlajvarashvAsagauravArucimAnnaraH|
mRuditairiva gAtraishca pIDitonmathitairiva||14||
mRuditairiva gAtraishca pIDitonmathitairiva||14||
shUnAkShikUTo haritaH shIrNalomA hataprabhaH|
shUnAkShikUTo haritaH shIrNalomA hataprabhaH|
kopanaH shishiradveShI nidrAluH ShThIvano~alpavAk||15||
kopanaH shishiradveShI nidrAluH ShThIvano~alpavAk||15||
piNDikodveShTakaTyUrupAdaruksadanAni ca|
piNDikodveShTakaTyUrupAdaruksadanAni ca|
bhavantyArohaNAyAsairvisheShashcAsya [1] vakShyate||16||
bhavantyArohaNAyAsairvisheShashcAsya [1] vakShyate||16||
</div></div>
On developing ''pandu roga'' the patients have the symptoms of tinnitus, low digestion, weakness, prostration, disliking for food, fatigue, giddiness, pain in the body, fever, dyspnea, heaviness and anorexia. The patient feels as if the limbs are being kneaded, pressed or churned; develops peri-orbital swelling, greenish complexion and falling of body hair. The person loses his body luster, becomes irritable, dislikes cold things, feels sleepy, spits in excess, avoids speaking, suffers from cramps in the calf region and experiences excessive fatigue as well as pain and weakness in the lumbar region, thighs and feet specifically by exertion while climbing [13-16]
On developing ''pandu roga'' the patients have the symptoms of tinnitus, low digestion, weakness, prostration, disliking for food, fatigue, giddiness, pain in the body, fever, dyspnea, heaviness and anorexia. The patient feels as if the limbs are being kneaded, pressed or churned; develops peri-orbital swelling, greenish complexion and falling of body hair. The person loses his body luster, becomes irritable, dislikes cold things, feels sleepy, spits in excess, avoids speaking, suffers from cramps in the calf region and experiences excessive fatigue as well as pain and weakness in the lumbar region, thighs and feet specifically by exertion while climbing [13-16]
The signs and symptoms specific to each variety of ''pandu'' will be described henceforth.
The signs and symptoms specific to each variety of ''pandu'' will be described henceforth.
=== ''Vatika pandu'' ===
<div class="mw-collapsible mw-collapsed">
आहारैरुपचारैश्च वातलैः कुपितोऽनिलः|
आहारैरुपचारैश्च वातलैः कुपितोऽनिलः|
जनयेत्कृष्णपाण्डुत्वं [१] तथा रूक्षारुणाङ्गताम्||१७||
जनयेत्कृष्णपाण्डुत्वं [१] तथा रूक्षारुणाङ्गताम्||१७||
अङ्गमर्दं रुजं तोदं कम्पं पार्श्वशिरोरुजम्|
अङ्गमर्दं रुजं तोदं कम्पं पार्श्वशिरोरुजम्|
वर्चःशोषास्यवैरस्यशोफानाहबलक्षयान्||१८||
वर्चःशोषास्यवैरस्यशोफानाहबलक्षयान्||१८||
<div class="mw-collapsible-content">
āhārairupacāraiśca Vātalaiḥ kupitō'nilaḥ|
āhārairupacāraiśca Vātalaiḥ kupitō'nilaḥ|
janayētkr̥ṣṇapāṇḍutvaṁ [1] tathā rūkṣāruṇāṅgatām||17||
janayētkr̥ṣṇapāṇḍutvaṁ [1] tathā rūkṣāruṇāṅgatām||17||
aṅgamardaṁ rujaṁ tōdaṁ kampaṁ pārśvaśirōrujam|
aṅgamardaṁ rujaṁ tōdaṁ kampaṁ pārśvaśirōrujam|
varcaḥśōṣāsyavairasyaśōphānāhabalakṣayān||18||
varcaḥśōṣāsyavairasyaśōphānāhabalakṣayān||18||
AhArairupacAraishca vAtalaiH kupito~anilaH|
AhArairupacAraishca vAtalaiH kupito~anilaH|
janayetkRuShNapANDutvaM [1] tathA rUkShAruNA~ggatAm||17||
janayetkRuShNapANDutvaM [1] tathA rUkShAruNA~ggatAm||17||
a~ggamardaM rujaM todaM kampaM pArshvashirorujam|
a~ggamardaM rujaM todaM kampaM pArshvashirorujam|
varcaHshoShAsyavairasyashophAnAhabalakShayAn||18||
varcaHshoShAsyavairasyashophAnAhabalakShayAn||18||
</div></div>
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'' ===
<div class="mw-collapsible mw-collapsed">
पित्तलस्याचितं पित्तं यथोक्तैः स्वैः प्रकोपणैः|
पित्तलस्याचितं पित्तं यथोक्तैः स्वैः प्रकोपणैः|
दूषयित्वा तु रक्तादीन् पाण्डुरोगाय कल्पते||१९||
दूषयित्वा तु रक्तादीन् पाण्डुरोगाय कल्पते||१९||
स पीतो हरिताभो वा ज्वरदाहसमन्वितः|
स पीतो हरिताभो वा ज्वरदाहसमन्वितः|
तृष्णामूर्च्छापिपासार्तः [१] पीतमूत्रशकृन्नरः||२०||
तृष्णामूर्च्छापिपासार्तः [१] पीतमूत्रशकृन्नरः||२०||
स्वेदनः शीतकामश्च न चान्नमभिनन्दति|
स्वेदनः शीतकामश्च न चान्नमभिनन्दति|
कटुकास्यो न चास्योष्णमुपशेतेऽम्लमेव च||२१||
कटुकास्यो न चास्योष्णमुपशेतेऽम्लमेव च||२१||
उद्गारोऽम्लो विदाहश्च विदग्धेऽन्नेऽस्य जायते|
उद्गारोऽम्लो विदाहश्च विदग्धेऽन्नेऽस्य जायते|
दौर्गन्ध्यं भिन्नवर्चस्त्वं दौर्बल्यं तम एव च||२२||
दौर्गन्ध्यं भिन्नवर्चस्त्वं दौर्बल्यं तम एव च||२२||
<div class="mw-collapsible-content">
Pittalasyācitaṁ Pittaṁ yathōktaiḥ svaiḥ prakōpaṇaiḥ|
Pittalasyācitaṁ Pittaṁ yathōktaiḥ svaiḥ prakōpaṇaiḥ|
dūṣayitvā tu raktādīn pāṇḍurōgāya kalpatē||19||
dūṣayitvā tu raktādīn pāṇḍurōgāya kalpatē||19||
sa pītō haritābhō vā jvaradāhasamanvitaḥ|
sa pītō haritābhō vā jvaradāhasamanvitaḥ|
tr̥ṣṇāmūrcchāpipāsārtaḥ [1] pītamūtraśakr̥nnaraḥ||20||
tr̥ṣṇāmūrcchāpipāsārtaḥ [1] pītamūtraśakr̥nnaraḥ||20||
svēdanaḥ śītakāmaśca na cānnamabhinandati|
svēdanaḥ śītakāmaśca na cānnamabhinandati|
kaṭukāsyō na cāsyōṣṇamupaśētē'mlamēva ca||21||
kaṭukāsyō na cāsyōṣṇamupaśētē'mlamēva ca||21||
udgārō'mlō vidāhaśca vidagdhē'nnē'sya jāyatē|
udgārō'mlō vidāhaśca vidagdhē'nnē'sya jāyatē|
daurgandhyaṁ bhinnavarcastvaṁ daurbalyaṁ tama ēva ca||22||
daurgandhyaṁ bhinnavarcastvaṁ daurbalyaṁ tama ēva ca||22||
pittalasyAcitaM pittaM yathoktaiH svaiH prakopaNaiH|
pittalasyAcitaM pittaM yathoktaiH svaiH prakopaNaiH|
dUShayitvA tu raktAdIn pANDurogAya kalpate||19||
dUShayitvA tu raktAdIn pANDurogAya kalpate||19||
sa pIto haritAbho vA jvaradAhasamanvitaH|
sa pIto haritAbho vA jvaradAhasamanvitaH|
tRuShNAmUrcchApipAsArtaH [1] pItamUtrashakRunnaraH||20||
tRuShNAmUrcchApipAsArtaH [1] pItamUtrashakRunnaraH||20||
svedanaH shItakAmashca na cAnnamabhinandati|
svedanaH shItakAmashca na cAnnamabhinandati|
kaTukAsyo na cAsyoShNamupashete~amlameva ca||21||
kaTukAsyo na cAsyoShNamupashete~amlameva ca||21||
udgAro~amlo vidAhashca vidagdhe~anne~asya jAyate|
udgAro~amlo vidAhashca vidagdhe~anne~asya jAyate|
daurgandhyaM bhinnavarcastvaM daurbalyaM tama eva ca||22||
daurgandhyaM bhinnavarcastvaM daurbalyaM tama eva ca||22||
</div></div>
[[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 ===
<div class="mw-collapsible mw-collapsed">
विवृद्धः श्लेष्मलैः श्लेष्मा पाण्डुरोगं स पूर्ववत्|
विवृद्धः श्लेष्मलैः श्लेष्मा पाण्डुरोगं स पूर्ववत्|
करोति गौरवं तन्द्रा छर्दिं श्वेतावभासताम्||२३||
करोति गौरवं तन्द्रा छर्दिं श्वेतावभासताम्||२३||
प्रसेकं लोमहर्षं च सादं मूर्च्छां भ्रमं क्लमम्|
प्रसेकं लोमहर्षं च सादं मूर्च्छां भ्रमं क्लमम्|
श्वासं कासं तथाऽऽलस्यमरुचिं वाक्स्वरग्रहम्||२४||
श्वासं कासं तथाऽऽलस्यमरुचिं वाक्स्वरग्रहम्||२४||
शुक्लमूत्राक्षिवर्चस्त्वं कटुरूक्षोष्णकामताम्|
शुक्लमूत्राक्षिवर्चस्त्वं कटुरूक्षोष्णकामताम्|
श्वयथुं मधुरास्यत्वमिति [१] पाण्ड्वामयः कफात्||२५||
श्वयथुं मधुरास्यत्वमिति [१] पाण्ड्वामयः कफात्||२५||
<div class="mw-collapsible-content">
vivr̥ddhaḥ ślēṣmalaiḥ ślēṣmā pāṇḍurōgaṁ sa pūrvavat|
vivr̥ddhaḥ ślēṣmalaiḥ ślēṣmā pāṇḍurōgaṁ sa pūrvavat|
karōti gauravaṁ tandrā chardiṁ śvētāvabhāsatām||23||
karōti gauravaṁ tandrā chardiṁ śvētāvabhāsatām||23||
prasēkaṁ lōmaharṣaṁ ca sādaṁ mūrcchāṁ bhramaṁ klamam|
prasēkaṁ lōmaharṣaṁ ca sādaṁ mūrcchāṁ bhramaṁ klamam|
śvāsaṁ kāsaṁ tathā''lasyamaruciṁ vāksvaragraham||24||
śvāsaṁ kāsaṁ tathā''lasyamaruciṁ vāksvaragraham||24||
śuklamūtrākṣivarcastvaṁ kaṭurūkṣōṣṇakāmatām|
śuklamūtrākṣivarcastvaṁ kaṭurūkṣōṣṇakāmatām|
śvayathuṁ madhurāsyatvamiti [1] pāṇḍvāmayaḥ kaphāt||25||
śvayathuṁ madhurāsyatvamiti [1] pāṇḍvāmayaḥ kaphāt||25||
vivRuddhaH shleShmalaiH shleShmA pANDurogaM sa pUrvavat|
vivRuddhaH shleShmalaiH shleShmA pANDurogaM sa pUrvavat|
karoti gauravaM tandrA chardiM shvetAvabhAsatAm||23||
karoti gauravaM tandrA chardiM shvetAvabhAsatAm||23||
prasekaM lomaharShaM ca sAdaM mUrcchAM bhramaM klamam|
prasekaM lomaharShaM ca sAdaM mUrcchAM bhramaM klamam|
shvAsaM kAsaM tathA~a~alasyamaruciM vAksvaragraham||24||
shvAsaM kAsaM tathA~a~alasyamaruciM vAksvaragraham||24||
shuklamUtrAkShivarcastvaM kaTurUkShoShNakAmatAm|
shuklamUtrAkShivarcastvaM kaTurUkShoShNakAmatAm|
shvayathuM madhurAsyatvamiti [1] pANDvAmayaH kaphAt||25||
shvayathuM madhurAsyatvamiti [1] pANDvAmayaH kaphAt||25||
</div></div>
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'' ===
<div class="mw-collapsible mw-collapsed">
सर्वान्नसेविनः सर्वे दुष्टा दोषास्त्रिदोषजम्|
सर्वान्नसेविनः सर्वे दुष्टा दोषास्त्रिदोषजम्|
त्रिदोषलिङ्गं कुर्वन्ति पाण्डुरोगं सुदुःसहम्||२६||
त्रिदोषलिङ्गं कुर्वन्ति पाण्डुरोगं सुदुःसहम्||२६||
<div class="mw-collapsible-content">
sarvānnasēvinaḥ sarvē duṣṭā dōṣāstridōṣajam|
sarvānnasēvinaḥ sarvē duṣṭā dōṣāstridōṣajam|
sarvAnnasevinaH sarve duShTA doShAstridoShajam|
sarvAnnasevinaH sarve duShTA doShAstridoShajam|
tridoShali~ggaM kurvanti pANDurogaM suduHsaham||26||
tridoShali~ggaM kurvanti pANDurogaM suduHsaham||26||
</div></div>
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'' ===
<div class="mw-collapsible mw-collapsed">
मृत्तिकादनशीलस्य कुप्यत्यन्यतमो मलः|
मृत्तिकादनशीलस्य कुप्यत्यन्यतमो मलः|
शूनगण्डाक्षिकूटभ्रूः [२] शूनपान्नाभिमेहनः|
शूनगण्डाक्षिकूटभ्रूः [२] शूनपान्नाभिमेहनः|
क्रिमिकोष्ठोऽतिसार्येत मलं सासृक् कफान्वितम्||३०||
क्रिमिकोष्ठोऽतिसार्येत मलं सासृक् कफान्वितम्||३०||
<div class="mw-collapsible-content">
mr̥ttikādanaśīlasya kupyatyanyatamō malaḥ|
mr̥ttikādanaśīlasya kupyatyanyatamō malaḥ|
shUnagaNDAkShikUTabhrUH [2] shUnapAnnAbhimehanaH|
shUnagaNDAkShikUTabhrUH [2] shUnapAnnAbhimehanaH|
krimikoShTho~atisAryeta malaM sAsRuk kaphAnvitam||30||
krimikoShTho~atisAryeta malaM sAsRuk kaphAnvitam||30||
</div></div>
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'' ===
<div class="mw-collapsible mw-collapsed">
पाण्डुरोगश्चिरोत्पन्नः खरीभूतो न सिध्यति|
पाण्डुरोगश्चिरोत्पन्नः खरीभूतो न सिध्यति|
स नास्त्यसृक्क्षयाद्यश्च पाण्डुः श्वेतत्वमाप्नुयात्|
स नास्त्यसृक्क्षयाद्यश्च पाण्डुः श्वेतत्वमाप्नुयात्|
इति पञ्चविधस्योक्तं पाण्डुरोगस्य लक्षणम्||३३||
इति पञ्चविधस्योक्तं पाण्डुरोगस्य लक्षणम्||३३||
<div class="mw-collapsible-content">
pāṇḍurōgaścirōtpannaḥ kharībhūtō na sidhyati|
pāṇḍurōgaścirōtpannaḥ kharībhūtō na sidhyati|
sa nAstyasRukkShayAdyashca pANDuH shvetatvamApnuyAt|
sa nAstyasRukkShayAdyashca pANDuH shvetatvamApnuyAt|
iti pa~jcavidhasyoktaM pANDurogasya lakShaNam||33||
iti pa~jcavidhasyoktaM pANDurogasya lakShaNam||33||
</div></div>
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.
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.
Thus, the signs and symptoms of all the five type of ''pandu roga'' have been described [31-33]
Thus, the signs and symptoms of all the five type of ''pandu roga'' have been described [31-33]
=== ''Koshthashakhashraya kamala'' ===
<div class="mw-collapsible mw-collapsed">
पाण्डुरोगी तु योऽत्यर्थं पित्तलानि निषेवते|
पाण्डुरोगी तु योऽत्यर्थं पित्तलानि निषेवते|
दाहाविपाकदौर्बल्यसदनारुचिकर्षितः|
दाहाविपाकदौर्बल्यसदनारुचिकर्षितः|
कामला बहुपित्तैषा कोष्ठशाखाश्रया मता||३६||
कामला बहुपित्तैषा कोष्ठशाखाश्रया मता||३६||
<div class="mw-collapsible-content">
pāṇḍurōgī tu yō'tyarthaṁ Pittalāni niṣēvatē|
pāṇḍurōgī tu yō'tyarthaṁ Pittalāni niṣēvatē|
dAhAvipAkadaurbalyasadanArucikarShitaH|
dAhAvipAkadaurbalyasadanArucikarShitaH|
kAmalA bahupittaiShA koShThashAkhAshrayA matA||36||
kAmalA bahupittaiShA koShThashAkhAshrayA matA||36||
</div></div>
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'' ===
<div class="mw-collapsible mw-collapsed">
कालान्तरात् खरीभूता कृच्छ्रा स्यात् कुम्भकामला| 36½ |
कालान्तरात् खरीभूता कृच्छ्रा स्यात् कुम्भकामला| 36½ |
<div class="mw-collapsible-content">
kālāntarāt kharībhūtā kr̥cchrā syāt kumbhakāmalā| 36½|
kālāntarāt kharībhūtā kr̥cchrā syāt kumbhakāmalā| 36½|
kAlAntarAt kharIbhUtA kRucchrA syAt kumbhakAmalA| 36½|
kAlAntarAt kharIbhUtA kRucchrA syAt kumbhakAmalA| 36½|
</div></div>
With the due course of time the disease (''kamala'') becomes deep seated (''kharibhuta'') resulting in excessive dryness of the body or afflicted tissue and thus becomes difficult to cure. This condition is called ''kumbha kamala'' [36½]
With the due course of time the disease (''kamala'') becomes deep seated (''kharibhuta'') resulting in excessive dryness of the body or afflicted tissue and thus becomes difficult to cure. This condition is called ''kumbha kamala'' [36½]
=== Bad prognostic symptoms of ''kamala'' ===
<div class="mw-collapsible mw-collapsed">
कृष्णपीतशकृन्मूत्रो [१] भृशं शूनश्च मानवः||३७||
कृष्णपीतशकृन्मूत्रो [१] भृशं शूनश्च मानवः||३७||
नष्टाग्निसञ्ज्ञः क्षिप्रं हि कामलावान् विपद्यते|38½|
नष्टाग्निसञ्ज्ञः क्षिप्रं हि कामलावान् विपद्यते|38½|
<div class="mw-collapsible-content">
kr̥ṣṇapītaśakr̥nmūtrō [1] bhr̥śaṁ śūnaśca mānavaḥ||37||
kr̥ṣṇapītaśakr̥nmūtrō [1] bhr̥śaṁ śūnaśca mānavaḥ||37||
naShTAgnisa~jj~jaH kShipraM hi kAmalAvAn vipadyate|38½|
naShTAgnisa~jj~jaH kShipraM hi kAmalAvAn vipadyate|38½|
</div></div>
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 ===
<div class="mw-collapsible mw-collapsed">
साध्यानामितरेषां तु प्रवक्ष्यामि चिकित्सितम्||३९||
साध्यानामितरेषां तु प्रवक्ष्यामि चिकित्सितम्||३९||
पञ्चगव्यं महातिक्तं कल्याणकमथापि वा|
पञ्चगव्यं महातिक्तं कल्याणकमथापि वा|
स्नेहनार्थं घृतं दद्यात् कामलापाण्डुरोगिणे||४३||
स्नेहनार्थं घृतं दद्यात् कामलापाण्डुरोगिणे||४३||
<div class="mw-collapsible-content">
sādhyānāmitarēṣāṁ tu pravakṣyāmi cikitsitam||39||
sādhyānāmitarēṣāṁ tu pravakṣyāmi cikitsitam||39||
pa~jcagavyaM mahAtiktaM kalyANakamathApi vA|
pa~jcagavyaM mahAtiktaM kalyANakamathApi vA|
snehanArthaM ghRutaM dadyAt kAmalApANDurogiNe||43||
snehanArthaM ghRutaM dadyAt kAmalApANDurogiNe||43||
</div></div>
Now, the treatment for the curable types of ''pandu roga'' is being described here:
Now, the treatment for the curable types of ''pandu roga'' is being described here:
The patient suffering from the ''pandu'' should first be given strong (''tikshna'') emetic and purgation therapies after the administration of internal oleation (''snehana'') for cleansing of the body (''shodhana'').
The patient suffering from the ''pandu'' should first be given strong (''tikshna'') emetic and purgation therapies after the administration of internal oleation ([[snehana]]) for cleansing of the body (''shodhana'').
On the other hand, patient of ''kamala'' should be given mild purgation therapy with bitter drugs. After the cleansing of the ''koshtha'' by the above procedures the patient of both of these diseases should be given wholesome food consisting of old ''shali'' rice, barley and wheat mixed with the ''yusha'' (vegetable soup) of ''mudga, adhaki'' and ''masura'', and the ''rasa'' (meat soup) of animals inhabiting the arid zone.
On the other hand, patient of ''kamala'' should be given mild purgation therapy with bitter drugs. After the cleansing of the ''koshtha'' by the above procedures the patient of both of these diseases should be given wholesome food consisting of old ''shali'' rice, barley and wheat mixed with the ''yusha'' (vegetable soup) of ''mudga, adhaki'' and ''masura'', and the ''rasa'' (meat soup) of animals inhabiting the arid zone.
On the basis of the aggravated ''doshas'' specific medicines are to be administered to the patients of these two categories (which will be described later in the chapter). For the oleation of the patient of ''pandu'' and ''kamala panchagavya ghrita, mahatikta ghrita'' and ''kalyanaka ghrita'' should be given [39-43]
On the basis of the aggravated [[dosha]] specific medicines are to be administered to the patients of these two categories (which will be described later in the chapter). For the oleation of the patient of ''pandu'' and ''kamala panchagavya ghrita, mahatikta ghrita'' and ''kalyanaka ghrita'' should be given [39-43]
=== ''Dadimadya ghritam'' ===
<div class="mw-collapsible mw-collapsed">
दाडिमात् कुडवो धान्यात् कुडवार्धं पलं पलम्|
दाडिमात् कुडवो धान्यात् कुडवार्धं पलं पलम्|
इति दाडिमाद्यं घृतम्|
इति दाडिमाद्यं घृतम्|
<div class="mw-collapsible-content">
dāḍimāt kuḍavō dhānyāt kuḍavārdhaṁ palaṁ palam|
dāḍimāt kuḍavō dhānyāt kuḍavārdhaṁ palaṁ palam|
iti dADimAdyaM ghRutam|
iti dADimAdyaM ghRutam|
</div></div>
Take twenty ''pala'' of ghee, one ''adhaka'' of water and add to it the paste prepared of one ''kudava'' of ''dadima'', half ''kudava'' of ''dhanya'', one ''pala'' each of ''chitraka'' and ''sringavera'' and one ''ashtamika'' (two ''karsha'') of ''pippali'' and prepare ghee as per method of ''sneha paka''. This medicated ghee stimulates the power of digestion. It cures heart disease, anemia, gulma, hemorrhoids, spleenomegaly and disorders of ''vata'' and ''kapha''. It is also useful for curing asthma, bronchitis, ''mudha-vata'' (claudication of ''vata'') and ''duhkha-prasava'' (difficult labor). It also helps a sterile woman to get offspring.
Take twenty ''pala'' of ghee, one ''adhaka'' of water and add to it the paste prepared of one ''kudava'' of ''dadima'', half ''kudava'' of ''dhanya'', one ''pala'' each of ''chitraka'' and ''sringavera'' and one ''ashtamika'' (two ''karsha'') of ''pippali'' and prepare ghee as per method of ''sneha paka''.This medicated ghee stimulates the power of digestion. It cures heart disease, anemia, gulma, hemorrhoids, spleenomegaly and disorders of [[vata]] and [[kapha]].It is also useful for curing asthma, bronchitis, ''mudha-vata'' (claudication of [[vata]]) and ''duhkha-prasava'' (difficult labor). It also helps a sterile woman to get offspring.
Thus, ends the description of ''dadimadyaghrita'' [44-46]
Thus, ends the description of ''dadimadyaghrita'' [44-46]
=== ''Katukadyam ghritam'' ===
<div class="mw-collapsible mw-collapsed">
कटुका रोहिणी मुस्तं हरिद्रे वत्सकात् पलम्|
कटुका रोहिणी मुस्तं हरिद्रे वत्सकात् पलम्|
इति कटुकाद्यं घृतम्|
इति कटुकाद्यं घृतम्|
<div class="mw-collapsible-content">
kaṭukā rōhiṇī mustaṁ haridrē vatsakāt palam|
kaṭukā rōhiṇī mustaṁ haridrē vatsakāt palam|
iti kaTukAdyaM ghRutam|
iti kaTukAdyaM ghRutam|
</div></div>
One ''pala'' each of ''katukarohini, musta, haridra, daruharidra, vatsaka'' in paste form, one ''karsha'' of each of ''patola, chandana, murva, trayamana, duralabha, krishna, parpataka, nimba, bhūnimba, devadaru'' should be added to one ''prastha'' of ''ghrita'' and four ''prasthas'' of milk. This medicated ghee cures ''raktapitta, jwara, daha, svayathu, bhagandara, arsha, asrigadara'' and ''visphotaka''. Thus described ''katukadya ghritam'' [47-49]
One ''pala'' each of ''katukarohini, musta, haridra, daruharidra, vatsaka'' in paste form, one ''karsha'' of each of ''patola, chandana, murva, trayamana, duralabha, krishna, parpataka, nimba, bhūnimba, devadaru'' should be added to one ''prastha'' of ''ghrita'' and four ''prasthas'' of milk. This medicated ghee cures ''raktapitta, jwara, daha, svayathu, bhagandara, arsha, asrigadara'' and ''visphotaka''. Thus described ''katukadya ghritam'' [47-49]
=== ''Pathya ghritam'' ===
<div class="mw-collapsible mw-collapsed">
पथ्याशतरसे पथ्यावृन्तार्धशतकल्कवान्|
पथ्याशतरसे पथ्यावृन्तार्धशतकल्कवान्|
इति पथ्याघृतम्|
इति पथ्याघृतम्|
<div class="mw-collapsible-content">
pathyāśatarasē pathyāvr̥ntārdhaśatakalkavān|
pathyāśatarasē pathyāvr̥ntārdhaśatakalkavān|
iti pathyAghRutam|
iti pathyAghRutam|
</div></div>
The decoction of one hundred fruits of ''haritaki'' and the paste of fifty stalks of ''haritaki'' fruits should be added to one ''prastha'' of ghee and cooked. This medicated ghee cures ''pandu'' and ''gulma'' [50]
The decoction of one hundred fruits of ''haritaki'' and the paste of fifty stalks of ''haritaki'' fruits should be added to one ''prastha'' of ghee and cooked. This medicated ghee cures ''pandu'' and ''gulma'' [50]
=== ''Danti ghritam'' ===
<div class="mw-collapsible mw-collapsed">
दन्त्याश्चतुष्पलरसे पिष्टैर्दन्तीशलाटुभिः|
दन्त्याश्चतुष्पलरसे पिष्टैर्दन्तीशलाटुभिः|
इति दन्तीघृतम्|
इति दन्तीघृतम्|
<div class="mw-collapsible-content">
dantyāścatuṣpalarasē piṣṭairdantīśalāṭubhiḥ|
dantyāścatuṣpalarasē piṣṭairdantīśalāṭubhiḥ|
iti dantIghRutam|
iti dantIghRutam|
</div></div>
One ''prastha'' of ghee should be cooked by adding (one ''prastha'' of) the decoction of four ''palas'' of ''danti'' and the paste of the green fruits of ''danti''. Intake of this medicated ghee cures ''pleeha'' (splenic disorders), ''pandu'' and edema [51]
One ''prastha'' of ghee should be cooked by adding (one ''prastha'' of) the decoction of four ''palas'' of ''danti'' and the paste of the green fruits of ''danti''. Intake of this medicated ghee cures ''pleeha'' (splenic disorders), ''pandu'' and edema [51]
=== ''Drakshaghritam'' ===
<div class="mw-collapsible mw-collapsed">
पुराणसर्पिषः प्रस्थो द्राक्षार्धप्रस्थसाधितः|
पुराणसर्पिषः प्रस्थो द्राक्षार्धप्रस्थसाधितः|
इति द्राक्षाघृतम्|
इति द्राक्षाघृतम्|
<div class="mw-collapsible-content">
purāṇasarpiṣaḥ prasthō drākṣārdhaprasthasādhitaḥ|
purāṇasarpiṣaḥ prasthō drākṣārdhaprasthasādhitaḥ|
iti drAkShAghRutam|
iti drAkShAghRutam|
</div></div>
One ''prastha'' of old ghee should be added to half a ''prastha'' of ''draksha'' and cooked. This medicated ghee cures ''kamala, gulma, pandu, jwara, meha'' (polyuria) and ''udara roga'' (generalized abdominal enlargement)[52]
One ''prastha'' of old ghee should be added to half a ''prastha'' of ''draksha'' and cooked. This medicated ghee cures ''kamala, gulma, pandu, jwara, meha'' (polyuria) and ''udara roga'' (generalized abdominal enlargement)[52]
=== ''Haridradi ghritam'' ===
<div class="mw-collapsible mw-collapsed">
हरिद्रात्रिफलानिम्बबलामधुकसाधितम्|
हरिद्रात्रिफलानिम्बबलामधुकसाधितम्|
इति हरिद्रादिघृतम्|
इति हरिद्रादिघृतम्|
<div class="mw-collapsible-content">
haridrātriphalānimbabalāmadhukasādhitam|
haridrātriphalānimbabalāmadhukasādhitam|
iti haridrAdighRutam|
iti haridrAdighRutam|
</div></div>
''Ghrita'' prepared with ''haridra, triphala, nimba, balā, madhuka'' and buffalo’s milk and ghee is an excellent cure for ''kamala'' [53]
''Ghrita'' prepared with ''haridra, triphala, nimba, balā, madhuka'' and buffalo’s milk and ghee is an excellent cure for ''kamala'' [53]
=== ''Darvyadi ghritam'' ===
<div class="mw-collapsible mw-collapsed">
गोमूत्रे द्विगुणे दार्व्याः कल्काक्षद्वयसाधितः|
गोमूत्रे द्विगुणे दार्व्याः कल्काक्षद्वयसाधितः|
माहिषात् सर्पिषः प्रस्थः पूर्वः पूर्वे परे परः|५५|
माहिषात् सर्पिषः प्रस्थः पूर्वः पूर्वे परे परः|५५|
<div class="mw-collapsible-content">
gōmūtrē dviguṇē dārvyāḥ kalkākṣadvayasādhitaḥ|
gōmūtrē dviguṇē dārvyāḥ kalkākṣadvayasādhitaḥ|
mAhiShAt sarpiShaH prasthaH pUrvaH pUrve pare paraH|55|
mAhiShAt sarpiShaH prasthaH pUrvaH pUrve pare paraH|55|
</div></div>
One ''prastha'' of buffalo’s ghee prepared by adding two ''prasthas'' of cow’s urine and the paste of two ''aksha'' of the paste of ''darvi'' as per ''sneha kalpana'' cures ''pandu roga''.
One ''prastha'' of buffalo’s ghee prepared by adding two ''prasthas'' of cow’s urine and the paste of two ''aksha'' of the paste of ''darvi'' as per ''sneha kalpana'' cures ''pandu roga''.
One ''prastha'' of buffalo’s ghee prepared by adding with the decoction of five ''palas'' of ''darvi'' and the paste of ''kaleeyaka'' as per ''sneha kalpana'' cures ''kamala'' [54-55]
One ''prastha'' of buffalo’s ghee prepared by adding with the decoction of five ''palas'' of ''darvi'' and the paste of ''kaleeyaka'' as per ''sneha kalpana'' cures ''kamala'' [54-55]
=== Preparations for ''pandu roga'' ===
<div class="mw-collapsible mw-collapsed">
स्नेहैरेभिरुपक्रम्य स्निग्धं मत्वा विरेचयेत्||५५||
स्नेहैरेभिरुपक्रम्य स्निग्धं मत्वा विरेचयेत्||५५||
सप्तरात्रं गवां मूत्रे भावितं वाऽप्ययोरजः|
सप्तरात्रं गवां मूत्रे भावितं वाऽप्ययोरजः|
पाण्डुरोगप्रशान्त्यर्थं पयसा पाययेद्भिषक्||६९||
पाण्डुरोगप्रशान्त्यर्थं पयसा पाययेद्भिषक्||६९||
<div class="mw-collapsible-content">
snēhairēbhirupakramya snigdhaṁ matvā virēcayēt||55||
snēhairēbhirupakramya snigdhaṁ matvā virēcayēt||55||
saptarAtraM gavAM mUtre bhAvitaM vA~apyayorajaH|
saptarAtraM gavAM mUtre bhAvitaM vA~apyayorajaH|
pANDurogaprashAntyarthaM payasA pAyayedbhiShak||69||
pANDurogaprashAntyarthaM payasA pAyayedbhiShak||69||
</div></div>
After proper oleation of the patient with the internal administration of the above described medicated ''ghrita,'' the patient should be given frequent medication with the following recipes:
After proper oleation of the patient with the internal administration of the above described medicated ''ghrita,'' the patient should be given frequent medication with the following recipes:
*Physicians should give ''lauha bhasma'' impregnated for seven nights with cow’s urine along with milk for the alleviation of ''pandu roga'' [55-69]
*Physicians should give ''lauha bhasma'' impregnated for seven nights with cow’s urine along with milk for the alleviation of ''pandu roga'' [55-69]
=== ''Navayasa churnam'' ===
<div class="mw-collapsible mw-collapsed">
त्र्यूषणत्रिफलामुस्तविडङ्गचित्रकाः समाः|
त्र्यूषणत्रिफलामुस्तविडङ्गचित्रकाः समाः|
इति नवायसचूर्णम्|
इति नवायसचूर्णम्|
<div class="mw-collapsible-content">
tryūṣaṇatriphalāmustaviḍaṅgacitrakāḥ samāḥ|
tryūṣaṇatriphalāmustaviḍaṅgacitrakāḥ samāḥ|
iti navAyasacUrNam|
iti navAyasacUrNam|
</div></div>
Take ''sunthi, pippali, maricha, haritaki, bibhitaki, amalaki, musta, vidanga'' and ''chitraka'' in one part each and nine parts of ''lauha bhasma'' and mix together. Intake of this recipe along with honey and ghee cures anemia, heart diseases, ''kushtha'' (group of skin diseases), ''arsha'' (hemorrhoids) and ''kamala''. This medicine propounded by ''krishnatreya'' is called ''navayasa churna'' [70-71]
Take ''sunthi, pippali, maricha, haritaki, bibhitaki, amalaki, musta, vidanga'' and ''chitraka'' in one part each and nine parts of ''lauha bhasma'' and mix together. Intake of this recipe along with honey and ghee cures anemia, heart diseases, ''kushtha'' (group of skin diseases), ''arsha'' (hemorrhoids) and ''kamala''. This medicine propounded by ''krishnatreya'' is called ''navayasa churna'' [70-71]
=== ''Mandura vataka'' ===
<div class="mw-collapsible mw-collapsed">
गुडनागरमण्डूरतिलांशान्मानतः समान्|
गुडनागरमण्डूरतिलांशान्मानतः समान्|
इति मण्डूरवटकाः|
इति मण्डूरवटकाः|
<div class="mw-collapsible-content">
guḍanāgaramaṇḍūratilāṁśānmānataḥ samān|
guḍanāgaramaṇḍūratilāṁśānmānataḥ samān|
iti maNDUravaTakAH|
iti maNDUravaTakAH|
</div></div>
''Mandura vataka'' – jaggery, ''sunthi, mandura'' and ''tila'' in one part each along with two parts of ''pippali'' should be triturated and made in the form of pills. This medicine is suitable for the treatment of the patients with ''pandu roga''.
''Mandura vataka'' – jaggery, ''shunthi, mandura'' and ''tila'' in one part each along with two parts of ''pippali'' should be triturated and made in the form of pills. This medicine is suitable for the treatment of the patients with ''pandu roga''.
''Sunthi, 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.
''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).
''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]
Thus ends the description of two types of ''mandura vataka''.[72-77]
=== ''Tapayadi lauha'' ===
<div class="mw-collapsible mw-collapsed">
ताप्याद्रिजतुरूप्यायोमलाः पञ्चपलाः पृथक्|
ताप्याद्रिजतुरूप्यायोमलाः पञ्चपलाः पृथक्|
कुलत्थकाकमाच्यादिकपोतपरिहारिणा|८०|
कुलत्थकाकमाच्यादिकपोतपरिहारिणा|८०|
<div class="mw-collapsible-content">
tāpyādrijaturūpyāyōmalāḥ pañcapalāḥ pr̥thak|
tāpyādrijaturūpyāyōmalāḥ pañcapalāḥ pr̥thak|
kulatthakAkamAcyAdikapotaparihAriNA|80|
kulatthakAkamAcyAdikapotaparihAriNA|80|
</div></div>
''Tapyadi yoga'' – ''Tapya, shilajatu,'' silver, ''mandura'' in the amount of five ''pala'' each should be added to one ''pala'' each of ''chitraka, haritaki, bibhitaka, amalaki, sunthi, pippali, maricha'' and ''vidanga''; and eight ''pala'' of sugar. This recipe should be taken by the patient habitually (by a ''pandu rogi'') in the dose of one ''karsha'' along with adequate amount of honey. After the digestion of this drug the patient should take wholesome food in small quantity and should avoid using ''kulattha, kakamachi'' etc. and pigeon meat [78-80]
''Tapyadi yoga'' – ''Tapya, shilajatu,'' silver, ''mandura'' in the amount of five ''pala'' each should be added to one ''pala'' each of ''chitraka, haritaki, bibhitaka, amalaki, sunthi, pippali, maricha'' and ''vidanga''; and eight ''pala'' of sugar. This recipe should be taken by the patient habitually (by a ''pandu rogi'') in the dose of one ''karsha'' along with adequate amount of honey. After the digestion of this drug the patient should take wholesome food in small quantity and should avoid using ''kulattha, kakamachi'' etc. and pigeon meat [78-80]
=== ''Yogaraja'' ===
<div class="mw-collapsible mw-collapsed">
त्रिफलायास्त्रयो भागास्त्रयस्त्रिकटुकस्य च||८०||
त्रिफलायास्त्रयो भागास्त्रयस्त्रिकटुकस्य च||८०||
इति योगराजः|
इति योगराजः|
<div class="mw-collapsible-content">
triphalāyāstrayō bhāgāstrayastrikaṭukasya ca||80||
triphalāyāstrayō bhāgāstrayastrikaṭukasya ca||80||
iti yogarAjaH|
iti yogarAjaH|
</div></div>
''Yogaraja'' – ''harītaki, bibhitaki, amalaki, shunthi, pippali, maricha, chitraka moola'' (root) and ''vidanga'' in the amount of one part each; five parts each of ''shilajatu, raupya mala'' (silver), purified ''makshika'' and ''lauha bhasma''; eight parts of sugar – all should be made to a fine powder and mixed with adequate amount of honey and kept in clean iron jar. This recipe should be taken by the patient in a quantity equal to a fruit of ''udumbara'' according to the power of digestion every day and should be given the desired food excluding ''kulattha, kakamachi'' etc. and pigeon meat; only after the digestion of the taken drug. This ambrosia like recipe is called ''yogaraja''. It is an excellent rejuvenative recipe which cures all diseases and bestows auspiciousness. It specially cures ''pandu'', poisoning, ''kasa, yakshma, vishama jwara'' (irregular fevers), ''ajeerna, meha, soshha, swasa, aruchi, apasmara'' (epilepsy), ''kamala'' and ''arsha''.
''Yogaraja'' – ''harītaki, bibhitaki, amalaki, shunthi, pippali, maricha, chitraka moola'' (root) and ''vidanga'' in the amount of one part each; five parts each of ''shilajatu, raupya mala'' (silver), purified ''makshika'' and ''lauha bhasma''; eight parts of sugar – all should be made to a fine powder and mixed with adequate amount of honey and kept in clean iron jar. This recipe should be taken by the patient in a quantity equal to a fruit of ''udumbara'' according to the power of digestion every day and should be given the desired food excluding ''kulattha, kakamachi'' etc. and pigeon meat; only after the digestion of the taken drug. This ambrosia like recipe is called ''yogaraja''. It is an excellent rejuvenative recipe which cures all diseases and bestows auspiciousness. It specially cures ''pandu'', poisoning, ''kasa, yakshma, vishama jwara'' (irregular fevers), ''ajeerna, meha, soshha, swasa, aruchi, apasmara'' (epilepsy), ''kamala'' and ''arsha''.
Thus ends the description of ''yogaraja'' [80-86]
Thus ends the description of ''yogaraja'' [80-86]
==== Preparations for ''pandu'' ====
=== Various formulations ===
=== Shilajatu Vataka ===
<div class="mw-collapsible mw-collapsed">
कौटजत्रिफलानिम्बपटोलघननागरैः||८७||
कौटजत्रिफलानिम्बपटोलघननागरैः||८७||
इति शिलाजतुवटकाः|
इति शिलाजतुवटकाः|
<div class="mw-collapsible-content">
kauṭajatriphalānimbapaṭōlaghananāgaraiḥ||87||
bhāvitāni daśāhāni rasairdvitriguṇāni vā|
bhāvitāni daśāhāni rasairdvitriguṇāni vā|
śilājatupalānyaṣṭau tāvatī sitaśarkarā||88||
śilājatupalānyaṣṭau tāvatī sitaśarkarā||88||
iti śilājatuvaṭakāḥ|
iti śilājatuvaṭakāḥ|
kauTajatriphalAnimbapaTolaghananAgaraiH||87||
kauTajatriphalAnimbapaTolaghananAgaraiH||87||
bhAvitAni dashAhAni rasairdvitriguNAni vA|
bhAvitAni dashAhAni rasairdvitriguNAni vA|
iti shilAjatuvaTakAH|
iti shilAjatuvaTakAH|
</div></div>
''Shilajatu vataka'' – Eight ''pala'' of ''shilajatu'' impregnated for ten, twenty or thirty days with the decoction of fruit of ''kutaja, haritaki, bibhitaka, amalaki, nimba, patola, ghana'' and ''nagara''. Eight ''pala'' of sugar and one ''pala'' each of ''tvakakshiri, pippali, dhatri'' and ''karkatashringi''; half ''pala'' each of the fruit and root of ''nidigdhika'' and adequate powder of ''tvaka, ela'' and ''patra'' should be added to this ''shilajatu''. ''Vataka'' (large sized pills) of one ''aksha'' each should be prepared by adding three ''pala'' of honey to this powder. These pills can be taken on either empty stomach or after having food. The patient should drink the juice of ''dadima'' (pomegranate), milk, meat soup of birds, water, alcohol, ''asava'' (medicated wine) after taking this medicine. It cures ''pandu, kushtha, jwara, pleeha, tamaka svasa, arsha, bhagandara'' (fistula in ano), ''puti'' (putrified ulcers), ''hridroga'' (heart diseases), ''shukra dosha'' (diseases of semen), ''mutra dosha'' (diseases of urine), and ''agni dosha'' (diseases of digestion), ''sosha'' (consumption), ''gara'' (poisoning), ''udara, kasa, asrigdara'' (menorrhagia), ''raktapitta'' (bleeding disorders), ''sotha, gulma, galamayana'' (diseases of the throats) and all types of ''vrana'' (wounds). It cures all types of diseases and bestows auspiciousness. Thus, ends the description of ''shilajatu vataka.'' [87-92]
=== Punarnava Mandura ===
<div class="mw-collapsible mw-collapsed">
पुनर्नवा त्रिवृद्व्योषविडङ्गं दारु चित्रकम्||९३||
कुष्ठं हरिद्रे त्रिफला दन्ती चव्यं कलिङ्गकाः|
पिप्पली [२] पिप्पलीमूलं मुस्तं चेति पलोन्मितम्||९४||
मण्डूरं द्विगुणं चूर्णाद्गोमूत्रे द्व्याढके पचेत्|
कोलवद्गुटिकाः कृत्वा तक्रेणालोड्य ना पिबेत्||९५||
ताः पाण्डुरोगान् प्लीहानमर्शांसि विषमज्वरम्|
श्वयथुं ग्रहणीदोषं हन्युः कुष्ठं क्रिमींस्तथा||९६||
इति पुनर्नवामण्डूरम्|
<div class="mw-collapsible-content">
punarnavā trivr̥dvyōṣaviḍaṅgaṁ dāru citrakam||93||
kuṣṭhaṁ haridrē triphalā dantī cavyaṁ kaliṅgakāḥ|
pippalī [2] pippalīmūlaṁ mustaṁ cēti palōnmitam||94||
maṇḍūraṁ dviguṇaṁ cūrṇādgōmūtrē dvyāḍhakē pacēt|
kōlavadguṭikāḥ kr̥tvā takrēṇālōḍya nā pibēt||95||
tāḥ pāṇḍurōgān plīhānamarśāṁsi viṣamajvaram|
śvayathuṁ grahaṇīdōṣaṁ hanyuḥ kuṣṭhaṁ krimīṁstathā||96||
iti punarnavāmaṇḍūram|
punarnavA trivRudvyoShaviDa~ggaM dAru citrakam||93||
kuShThaM haridre triphalA dantI cavyaM kali~ggakAH|
pippalI [2] pippalImUlaM mustaM ceti palonmitam||94||
maNDUraM dviguNaM cUrNAdgomUtre dvyADhake pacet|
kolavadguTikAH kRutvA takreNAloDya nA pibet||95||
tAH pANDurogAn plIhAnamarshAMsi viShamajvaram|
shvayathuM grahaNIdoShaM hanyuH kuShThaM krimIMstathA||96||
iti punarnavAmaNDUram|
</div></div>
Powder of one ''pala'' each of ''punarnava, trivritta, sunthi, pippali, maricha, vidanga, devadaru, chitraka, kushtha, haridra, daruharidra, haritaki, bibhitaka, amalaki, danti, chavya, kālingaka, pippalī, pippalimoola'' and ''musta''; and forty ''pala'' of ''mandura bhasma'' (rust of iron) coked in two ''adhaka'' of cow’s urine and made in the form of ''gutika'' of the size of ''kola''. These pills should be taken with butter milk. It cures ''pandu, pleeha, arsha, vishama jwara, sotha, grahanidosha'' (sprue syndrome, irritable bowel syndrome), ''kushtha'' and ''krimi'' (parasitic infestation). Thus, ends the description of ''punarnava mandura''.[93-96]
iti dhātryavalēhaḥ|
==== Mandūravatakāh ====
=== Darvyadi leha and other two recipes ===
<div class="mw-collapsible mw-collapsed">
दार्वीत्वक् त्रिफला व्योषं विडङ्गमयसो रजः|
मधुसर्पिर्युतं लिह्यात् कामलापाण्डुरोगवान्||९७||
तुल्या अयोरजःपथ्याहरिद्राः क्षौद्रसर्पिषा|
चूर्णिताः कामली लिह्याद्गुडक्षौद्रेण वाऽभयाः||९८||
त्रिफला द्वे हरिद्रे च कटुरोहिण्ययोरजः|
चूर्णितं क्षौद्रसर्पिर्भ्यां स लेहः कामलापहः||९९||
<div class="mw-collapsible-content">
dārvītvak triphalā vyōṣaṁ viḍaṅgamayasō rajaḥ|
madhusarpiryutaṁ lihyāt kāmalāpāṇḍurōgavān||97||
tulyā ayōrajaḥpathyāharidrāḥ kṣaudrasarpiṣā|
cūrṇitāḥ kāmalī lihyādguḍakṣaudrēṇa vā'bhayāḥ||98||
triphalā dvē haridrē ca kaṭurōhiṇyayōrajaḥ|
cūrṇitaṁ kṣaudrasarpirbhyāṁ sa lēhaḥ kāmalāpahaḥ||99||
dArvItvak triphalA vyoShaM viDa~ggamayaso rajaH|
madhusarpiryutaM lihyAt kAmalApANDurogavAn||97||
tulyA ayorajaHpathyAharidrAH kShaudrasarpiShA|
cUrNitAH kAmalI lihyAdguDakShaudreNa vA~abhayAH||98||
triphalA dve haridre ca kaTurohiNyayorajaH|
cUrNitaM kShaudrasarpirbhyAM sa lehaH kAmalApahaH||99||
</div></div>
Powder of the bark of daruharidra, haritaki, bibhitaka, amalaki, pippali, sunthi, maricha, vidanga and lauha bhasma mixed with ghee and honey, taken as a linctus by the patients suffering from ''pandu'' and ''kamala''.
Two other recipes – Patients suffering from ''kamala'' should take the powder of one part each of ''lauha bhasma, haritaki'' and ''haridra'' along with honey and ghee and may also take the linctus of the powder of ''abhaya'' prepared by mixing with jaggery and honey. [97-99]
==== Dhātryariṣṭa ====
=== ''Dhatryavaleha'' ===
<div class="mw-collapsible mw-collapsed">
द्विपलांशां तुगाक्षीरीं नागरं मधुयष्टिकाम्|
प्रास्थिकीं पिप्पलीं द्राक्षां शर्करार्धतुलां शुभाम्||१००||
धात्रीफलरसद्रोणे चूर्णितं लेहवत् पचेत्|
शीतं मधुप्रस्थयुतं लिह्यात् पाणितलं ततः||१०१||
हन्त्येष कामलां पित्तं पाण्डुं कासं हलीमकम्|
इति धात्र्यवलेहः|
<div class="mw-collapsible-content">
dvipalāṁśāṁ tugākṣīrīṁ nāgaraṁ madhuyaṣṭikām|
prāsthikīṁ pippalīṁ drākṣāṁ śarkarārDhātulāṁ śubhām||100||
dhātrīphalarasadrōṇē cūrṇitaṁ lēhavat pacēt|
śītaṁ madhuprasthayutaṁ lihyāt pāṇitalaṁ tataḥ||101||
hantyēṣa kāmalāṁ Pittaṁ pāṇḍuṁ kāsaṁ halīmakam|
==== Treatment of mrittikā bhakṡaṇa janya pāndu ====
iti dhātryavalēhaḥ|
dvipalAMshAM tugAkShIrIM nAgaraM madhuyaShTikAm|
prAsthikIM pippalIM drAkShAM sharkarArdhatulAM shubhAm||100||
dhAtrIphalarasadroNe cUrNitaM lehavat pacet|
shItaM madhuprasthayutaM lihyAt pANitalaM tataH||101||
hantyeSha kAmalAM pittaM pANDuM kAsaM halImakam|
iti dhAtryavalehaH|
</div></div>
''Dhatryavaleha'' – ''Vanshalochana, sunthi, maduyashti'' powders, each in two ''pala''; one ''prastha'' each of ''pippali'' and ''draksha''; and half a ''tula'' of sugar crystal added with one ''drona'' of ''amalaki'' fruit juice and cooked till it changes into linctus form. One ''prastha'' of honey is added to it after it cools down. Intake of one ''panitala'' of this linctus cures ''kamala, [[pitta]] vikaras, pandu, kasa'' and ''haleemaka'' [100-101]
=== ''Mandura vatakah'' ===
<div class="mw-collapsible mw-collapsed">
त्र्यूषणं त्रिफला चव्यं चित्रको देवदारु च||१०२||
विडङ्गान्यथ मुस्तं च वत्सकं चेति चूर्णयेत्|
मण्डूरतुल्यं तच्चूर्णं गोमूत्रेऽष्टगुणे पचेत्||१०३||
शनैः सिद्धास्तथा शीताः कार्याः कर्षसमा गुडाः|
यथाग्नि भक्षणीयास्ते प्लीहपाण्ड्वामयापहाः||१०४||
ग्रहण्यर्शोनुदश्चैव तक्रवाट्याशिनः स्मृताः|
इति मण्डूरवटकाः|
<div class="mw-collapsible-content">
tryūṣaṇaṁ triphalā cavyaṁ citrakō dēvadāru ca||102||
viḍaṅgānyatha mustaṁ ca vatsakaṁ cēti cūrṇayēt|
maṇḍūratulyaṁ taccūrṇaṁ gōmūtrē'ṣṭaguṇē pacēt||103||
śanaiḥ siddhāstathā śītāḥ kāryāḥ karṣasamā guḍāḥ|
yathāgni bhakṣaṇīyāstē plīhapāṇḍvāmayāpahāḥ||104||
grahaṇyarśōnudaścaiva takravāṭyāśinaḥ smr̥tāḥ|
iti maṇḍūravaṭakāḥ|
tryUShaNaM triphalA cavyaM citrako devadAru ca||102||
viDa~ggAnyatha mustaM ca vatsakaM ceti cUrNayet|
maNDUratulyaM taccUrNaM gomUtre~aShTaguNe pacet||103||
shanaiH siddhAstathA shItAH kAryAH karShasamA guDAH|
yathAgni bhakShaNIyAste plIhapANDvAmayApahAH||104||
grahaNyarshonudashcaiva takravATyAshinaH smRutAH|
iti maNDUravaTakAH|
</div></div>
''Mandura Vataka''-II: ''Shunthi, pippali, maricha, haritaki, bibhitaka, amalaki, chavya, chitraka, devadaru, vidanga, musta'' and ''vatsaka'' in one part each, made in the form of powder and added to equal quantity (12 parts) of ''mandura bhasma'', should then be boiled by adding eight times of cow’s urine over mild fire. After the recipe cools pills of one ''aksha'' each should be prepared and taken according to the power of digestion. This cures ''pleeha, pandu, grahani,'' and ''arsha''. The patient should take buttermilk and ''vatya'' (a roasted barley preperation) while taking this pill [102-104]
=== ''Gaudo arishta'' ===
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मञ्जिष्ठा रजनी द्राक्षा बलामूलान्ययोरजः||१०५||
लोध्रं चैतेषु गौडः स्यादरिष्टः पाण्डुरोगिणाम्|
इति गौडोऽरिष्टः|
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mañjiṣṭhā rajanī drākṣā balāmūlānyayōrajaḥ||105||
lōdhraṁ caitēṣu gauḍaḥ syādariṣṭaḥ pāṇḍurōgiṇām|
iti gauḍō'riṣṭaḥ|
ma~jjiShThA rajanI drAkShA balAmUlAnyayorajaH||105||
lodhraM caiteShu gauDaH syAdariShTaH pANDurogiNAm|
iti gauDo~ariShTaH|
</div></div>
''Manjishtha, rajani, draksha, bala moola'' (roots), ''lauha bhasma'', and ''lodhra'' should be added to jaggery and processed according to the method prescribed for ''arishta''. It is called ''gaudo-arishta'' and is useful for the patients suffering from ''pandu roga'' [105]
=== ''Beejakarishta'' ===
<div class="mw-collapsible mw-collapsed">
बीजकात्षोडशपलं त्रिफलायाश्च विंशतिः||१०६||
द्राक्षायाः पञ्च लाक्षायाः सप्त द्रोणे जलस्य तत्|
साध्यं पादावशेषे तु पूतशेषे समावपेत्||१०७||
शर्करायास्तुलां प्रस्थं माक्षिकस्य च कार्षिकम्|
व्योषं व्याघ्रनखोशीरं क्रमुकं सैलवालुकम्||१०८||
मधुकं कुष्ठमित्येतच्चूर्णितं घृतभाजने|
यवेषु दशरात्रं तद्ग्रीष्मे द्विः शिशिरे स्थितम्||१०९||
पिबेत्तद्ग्रहणीपाण्डुरोगार्शःशोथगुल्मनुत्|
मूत्रकृच्छ्राश्मरीमेहकामलासन्निपातजित्||११०||
बीजकारिष्ट इत्येष आत्रेयेण प्रकीर्तितः|
इति बीजकारिष्टः|
<div class="mw-collapsible-content">
bījakātṣōḍaśapalaṁ triphalāyāśca viṁśatiḥ||106||
drākṣāyāḥ pañca lākṣāyāḥ sapta drōṇē jalasya tat|
sādhyaṁ pādāvaśēṣē tu pūtaśēṣē samāvapēt||107||
śarkarāyāstulāṁ prasthaṁ mākṣikasya ca kārṣikam|
vyōṣaṁ vyāghranakhōśīraṁ kramukaṁ sailavālukam||108||
madhukaṁ kuṣṭhamityētaccūrṇitaṁ ghr̥tabhājanē|
yavēṣu daśarātraṁ tadgrīṣmē dviḥ śiśirē sthitam||109||
pibēttadgrahaṇīpāṇḍurōgārśaḥśōthagulmanut|
mūtrakr̥cchrāśmarīmēhakāmalāsannipātajit||110||
bījakāriṣṭa ityēṣa ātrēyēṇa prakīrtitaḥ|
iti bījakāriṣṭaḥ|
bIjakAtShoDashapalaM triphalAyAshca viMshatiH||106||
drAkShAyAH pa~jca lAkShAyAH sapta droNe jalasya tat|
sAdhyaM pAdAvasheShe tu pUtasheShe samAvapet||107||
sharkarAyAstulAM prasthaM mAkShikasya ca kArShikam|
vyoShaM vyAghranakhoshIraM kramukaM sailavAlukam||108||
madhukaM kuShThamityetaccUrNitaM ghRutabhAjane|
yaveShu dasharAtraM tadgrIShme dviH shishire sthitam||109||
pibettadgrahaNIpANDurogArshaHshothagulmanut|
mUtrakRucchrAshmarImehakAmalAsannipAtajit||110||
bIjakAriShTa ityeSha AtreyeNa prakIrtitaH|
iti bIjakAriShTaH|
</div></div>
''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]
=== ''Dhatryarishta'' ===
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धात्रीफलसहस्रे द्वे पीडयित्वा रसं तु तम्||१११||
क्षौद्राष्टांशेन संयुक्तं कृष्णार्धकुडवेन च|
शर्करार्धतुलोन्मिश्रं पक्षं स्निग्धघटे स्थितम्||११२||
प्रपिबेन्मात्रया प्रातर्जीर्णे हितमिताशनः|
कामलापाण्डुहृद्रोगवातासृग्विषमज्वरान्||११३||
कासहिक्कारुचिश्वासांश्चैषोऽरिष्टः प्रणाशयेत्|
इति धात्र्यरिष्टः
<div class="mw-collapsible-content">
dhātrīphalasahasrē dvē pīḍayitvā rasaṁ tu tam||111||
kṣaudrāṣṭāṁśēna saṁyuktaṁ kr̥ṣṇārdhakuḍavēna ca|
śarkarārDhātulōnmiśraṁ pakṣaṁ snigdhaghaṭē sthitam||112||
prapibēnmātrayā prātarjīrṇē hitamitāśanaḥ|
kāmalāpāṇḍuhr̥drōgavātāsr̥gviṣamajvarān||113||
kāsahikkāruciśvāsāṁścaiṣō'riṣṭaḥ praṇāśayēt|
iti dhātryariṣṭaḥ|
dhAtrIphalasahasre dve pIDayitvA rasaM tu tam||111||
kShaudrAShTAMshena saMyuktaM kRuShNArdhakuDavena ca|
sharkarArdhatulonmishraM pakShaM snigdhaghaTe sthitam||112||
prapibenmAtrayA prAtarjIrNe hitamitAshanaH|
kAmalApANDuhRudrogavAtAsRugviShamajvarAn||113||
kAsahikkArucishvAsAMshcaiSho~ariShTaH praNAshayet|
iti dhAtryariShTaH|
</div></div>
''Dhatryarishta'' - Two thousand fruits of ''amalaki'' should be crushed and the juice extracted should be mixed with one eighth the quantity of honey, half ''kudava'' of ''pippali'' and half ''tula'' of sugar. It should then be kept in an earthern jar smeared with ghee for one fortnight. It should be taken in appropriate dose in the morning and the patient should take wholesome food in small quantity after the digestion of the drug. This ''arishta'' cures ''kamala, pandu, hridroga, vatarakta, vishama jwara, kasa, hikka, aruchi'' and ''svasa''. Thus, ends the description of ''dhatrya arishta'' [111-113]
=== Medicated water ===
<div class="mw-collapsible mw-collapsed">
स्थिरादिभिः शृतं तोयं पानाहारे प्रशस्यते||११४||
पाण्डूनां, कामलार्तानां मृद्वीकामलकीरसः|११५|
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sthirādibhiḥ śr̥taṁ tōyaṁ pānāhārē praśasyatē||114||
pāṇḍūnāṁ, kāmalārtānāṁ mr̥dvīkāmalakīrasaḥ|115|
sthirAdibhiH shRutaM toyaM pAnAhAre prashasyate||114||
pANDUnAM, kAmalArtAnAM mRudvIkAmalakIrasaH|115|
</div></div>
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]
=== Principles of treatment according to [[dosha]] ===
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पाण्डुरोगप्रशान्त्यर्थमिति प्रोक्तं महर्षिणा||११५||
विकल्प्यमेतद्भिषजा पृथग्दोषबलं प्रति|
वातिके स्नेहभूयिष्ठं, पैत्तिके तिक्तशीतलम्||११६||
श्लैष्मिके कटुतिक्तोष्णं [१] , विमिश्रं सान्निपातिके|११७|
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pāṇḍurōgapraśāntyarthamiti prōktaṁ maharṣiṇā||115||
vikalpyamētadbhiṣajā pr̥thagdōṣabalaṁ prati|
vātikē snēhabhūyiṣṭhaṁ, paittikē tiktaśītalam||116||
ślaiṣmikē kaṭutiktōṣṇaṁ [1] , vimiśraṁ sānnipātikē|117|
pANDurogaprashAntyarthamiti proktaM maharShiNA||115||
vikalpyametadbhiShajA pRuthagdoShabalaM prati|
vAtike snehabhUyiShThaM, paittike tiktashItalam||116||
shlaiShmike kaTutiktoShNaM [1] , vimishraM sAnnipAtike|117|
</div></div>
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 [[kapha]]ja type of ''pandu'' [115-117]
=== Treatment of ''mrittika bhakshanajanya pandu'' ===
<div class="mw-collapsible mw-collapsed">
निपातयेच्छरीरात्तु मृत्तिकां भक्षितां भिषक्||११७||
युक्तिज्ञः शोधनैस्तीक्ष्णैः प्रसमीक्ष्य बलाबलम्|
शुद्धकायस्य सर्पींषि बलाधानानि योजयेत्||११८||
व्योषं बिल्वं हरिद्रे द्वे त्रिफला द्वे पुनर्नवे|
मुस्तान्ययोरजः पाठा विडङ्गं देवदारु च||११९||
वृश्चिकाली च भार्गी च सक्षीरैस्तैः [१] समैर्घृतम्|
साधयित्वा पिबेद्युक्त्या नरो मृद्दोषपीडितः||१२०||
तद्वत् केशरयष्ट्याह्वपिप्पलीक्षारशाद्वलैः|
मृद्भक्षणादातुरस्य लौल्यादविनिवर्तिनः||१२१||
द्वेष्यार्थं भावितां कामं दद्यात्तद्दोषनाशनैः|
विङ्गैलातिविषया निम्बपत्रेण पाठया||१२२||
वार्ताकैः कटुरोहिण्या कौटजैर्मूर्वयाऽपि वा|१२३|
वार्ताकैः कटुरोहिण्या कौटजैर्मूर्वयाऽपि वा|१२३|
nipātayēccharīrāttu mr̥ttikāṁ bhakṣitāṁ bhiṣak||117||
<div class="mw-collapsible-content">
yuktijñaḥ śōdhanaistīkṣṇaiḥ prasamīkṣya balābalam|
śuddhakāyasya sarpīṁṣi balādhānāni yōjayēt||118||
nipātayēccharīrāttu mr̥ttikāṁ bhakṣitāṁ bhiṣak||117||
vyōṣaṁ bilvaṁ haridrē dvē triphalā dvē punarnavē|
mustānyayōrajaḥ pāṭhā viḍaṅgaṁ dēvadāru ca||119||
yuktijñaḥ śōdhanaistīkṣṇaiḥ prasamīkṣya balābalam|
vr̥ścikālī ca bhārgī ca sakṣīraistaiḥ [1] samairghr̥tam|
śuddhakāyasya sarpīṁṣi balādhānāni yōjayēt||118||
sādhayitvā pibēdyuktyā narō mr̥ddōṣapīḍitaḥ||120||
tadvat kēśarayaṣṭyāhvapippalīkṣāraśādvalaiḥ|
vyōṣaṁ bilvaṁ haridrē dvē triphalā dvē punarnavē|
mr̥dbhakṣaṇādāturasya laulyādavinivartinaḥ||121||
mustānyayōrajaḥ pāṭhā viḍaṅgaṁ dēvadāru ca||119||
dvēṣyārthaṁ bhāvitāṁ kāmaṁ dadyāttaddōṣanāśanaiḥ|
viṅgailātiviṣayā nimbapatrēṇa pāṭhayā||122||
vr̥ścikālī ca bhārgī ca sakṣīraistaiḥ [1] samairghr̥tam|
vārtākaiḥ kaṭurōhiṇyā kauṭajairmūrvayā'pi vā|123|
sādhayitvā pibēdyuktyā narō mr̥ddōṣapīḍitaḥ||120||
nipAtayeccharIrAttu mRuttikAM bhakShitAM bhiShak||117||
yuktij~jaH shodhanaistIkShNaiH prasamIkShya balAbalam|
tadvat kēśarayaṣṭyāhvapippalīkṣāraśādvalaiḥ|
shuddhakAyasya sarpIMShi balAdhAnAni yojayet||118||
mr̥dbhakṣaṇādāturasya laulyādavinivartinaḥ||121||
vyoShaM bilvaM haridre dve triphalA dve punarnave|
mustAnyayorajaH pAThA viDa~ggaM devadAru ca||119||
dvēṣyārthaṁ bhāvitāṁ kāmaṁ dadyāttaddōṣanāśanaiḥ|
vRushcikAlI ca bhArgI ca sakShIraistaiH [1] samairghRutam|
viṅgailātiviṣayā nimbapatrēṇa pāṭhayā||122||
sAdhayitvA pibedyuktyA naro mRuddoShapIDitaH||120||
tadvat kesharayaShTyAhvapippalIkShArashAdvalaiH|
vārtākaiḥ kaṭurōhiṇyā kauṭajairmūrvayā'pi vā|123|
mRudbhakShaNAdAturasya laulyAdavinivartinaH||121||
dveShyArthaM bhAvitAM kAmaM dadyAttaddoShanAshanaiH|
nipAtayeccharIrAttu mRuttikAM bhakShitAM bhiShak||117||
vi~ggailAtiviShayA nimbapatreNa pAThayA||122||
vArtAkaiH kaTurohiNyA kauTajairmUrvayA~api vA|123|
yuktij~jaH shodhanaistIkShNaiH prasamIkShya balAbalam|
A physician well versed in therapeutics, should give the patient strong elimination therapy, keeping in view the strength of the patient, in order to remove the swallowed mud from the body. After the body is cleansed, different types of medicated ghee should be prescribed to the patient for promotion of strength.
shuddhakAyasya sarpIMShi balAdhAnAni yojayet||118||
Ghee prepared with sunṭhī, pippali, maricha, bilva, haridrā, dāruharidrā, harītakī, bibhītaka, amalakī, sveta and rakta punarnavā, mustā, lauha bhasma, pāthā, vydanga, devadāru, vṛścikālī, bhārgī and milk should be appropriately taken by the patient who suffers from anemia because of swallowing clay.
Likewise, ghee prepared with keśara, yaśtmadhu, pippali, kṡāra (alkali preperation) and sadvāla may be given to the patient suffering from mritikā bhakśaṇa janya pāndu.
vyoShaM bilvaM haridre dve triphalA dve punarnave|
If the paient is unable to give up his clay swallowing habits, he should be given clay impregnated with viḍanga, elā, ativiśā, neem leaves, pāṭhā, varātaka, kaṭurohiṇī, kuṭaja or mūrvā with a view of creating an aversion to clay. These drugs also counter act the adverse effects of clay swallowing (117-123).
mustAnyayorajaH pAThA viDa~ggaM devadAru ca||119||
vRushcikAlI ca bhArgI ca sakShIraistaiH [1] samairghRutam|
sAdhayitvA pibedyuktyA naro mRuddoShapIDitaH||120||
tadvat kesharayaShTyAhvapippalIkShArashAdvalaiH|
mRudbhakShaNAdAturasya laulyAdavinivartinaH||121||
dveShyArthaM bhAvitAM kAmaM dadyAttaddoShanAshanaiH|
vi~ggailAtiviShayA nimbapatreNa pAThayA||122||
vArtAkaiH kaTurohiNyA kauTajairmUrvayA~api vA|123|
</div></div>
A physician well versed in therapeutics, should give the patient strong elimination therapy, keeping in view the strength of the patient, in order to remove the swallowed mud from the body. After the body is cleansed, different types of medicated ghee should be prescribed to the patient for promotion of strength.
Ghee prepared with ''shunthi, pippali, maricha, bilva, haridra, daruharidra, haritaki, bibhitaka, amalaki, sveta'' and ''rakta punarnava, musta, lauha bhasma, patha, vidanga, devadaru, vrishchikali, bhargi'' and milk should be appropriately taken by the patient who suffers from anemia because of eating clay.
Likewise, ghee prepared with ''keshara, yashtamadhu, pippali, kshara'' (alkali preperation) and ''sadvala'' may be given to the patient suffering from ''mrittika bhakshana janya pandu''.
If the patient is unable to give up his clay swallowing habits, he should be given clay impregnated with ''vidanga, ela, ativisha,'' neem leaves, ''patha, varataka, katurohiṇī, kutaja'' or ''murva'' with a view of creating an aversion to clay. These drugs also counter act the adverse effects of eating clay. [117-123]
<div class="mw-collapsible mw-collapsed">
यथादोषं प्रकुर्वीत भैषज्यं पाण्डुरोगिणाम्||१२३||
क्रियाविशेष एषोऽस्य मतो हेतुविशेषतः|१२४|
<div class="mw-collapsible-content">
yathādōṣaṁ prakurvīta bhaiṣajyaṁ pāṇḍurōgiṇām||123||
kriyāviśēṣa ēṣō'sya matō hētuviśēṣataḥ|124|
yathAdoShaM prakurvIta bhaiShajyaM pANDurogiNAm||123||
kriyAvisheSha eSho~asya mato hetuvisheShataH|124|
</div></div>
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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तिलपिष्टनिभं यस्तु वर्चः सृजति कामली||१२४||
श्लेष्मणा रुद्धमार्गं तत् पित्तं कफहरैर्जयेत्|
रूक्षशीतगुरुस्वादुव्यायामैर्वेगनिग्रहैः||१२५||
कफसम्मूर्च्छितो वायुः स्थानात् पित्तं क्षिपेद्बली|
हारिद्रनेत्रमूत्रत्वक् श्वेतवर्चास्तदा नरः||१२६||
भवेत् साटोपविष्टम्भो गुरुणा हृदयेन च|
दौर्बल्याल्पाग्निपार्श्वार्तिहिक्काश्वासारुचिज्वरैः||१२७||
क्रमेणाल्पेऽनुसज्येत [१] पित्ते शाखासमाश्रिते|१२८|
<div class="mw-collapsible-content">
tilapiṣṭanibhaṁ yastu varcaḥ sr̥jati kāmalī||124||
ślēṣmaṇā ruddhamārgaṁ tat Pittaṁ Kaphaharairjayēt|
rūkṣaśītagurusvāduvyāyāmairvēganigrahaiḥ||125||
Kaphasammūrcchitō vāyuḥ sthānāt Pittaṁ kṣipēdbalī|
hāridranētramūtratvak śvētavarcāstadā naraḥ||126||
bhavēt sāṭōpaviṣṭambhō guruṇā hr̥dayēna ca|
daurbalyālpāgnipārśvārtihikkāśvāsārucijvaraiḥ||127||
kramēṇālpē'nusajyēta [1] pittē śākhāsamāśritē|128|
tilapiShTanibhaM yastu varcaH sRujati kAmalI||124||
shleShmaNA ruddhamArgaM tat pittaM kaphaharairjayet|
rUkShashItagurusvAduvyAyAmairveganigrahaiH||125||
kaphasammUrcchito vAyuH sthAnAt pittaM kShipedbalI|
hAridranetramUtratvak shvetavarcAstadA naraH||126||
bhavet sATopaviShTambho guruNA hRudayena ca|
daurbalyAlpAgnipArshvArtihikkAshvAsArucijvaraiH||127||
krameNAlpe~anusajyeta [1] pitte shAkhAsamAshrite|128|
</div></div>
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]].
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]
=== Treatment of ''shakhashriat kamala'' ===
<div class="mw-collapsible mw-collapsed">
बर्हितित्तिरिदक्षाणां रूक्षाम्लैः कटुकै रसैः||१२८||
शुष्कमूलककौलत्थैर्यूषैश्चान्नानि भोजयेत्|
मातुलुङ्गरसं क्षौद्रपिप्पलीमरिचान्वितम्||१२९||
सनागरं पिबेत् पित्तं तथाऽस्यैति स्वमाशयम्|१३०|
<div class="mw-collapsible-content">
barhitittiridakṣāṇāṁ rūkṣāmlaiḥ kaṭukai rasaiḥ||128||
śuṣkamūlakakaulatthairyūṣaiścānnāni bhōjayēt|
mātuluṅgarasaṁ kṣaudrapippalīmaricānvitam||129||
sanāgaraṁ pibēt Pittaṁ tathā'syaiti svamāśayam|130|
barhitittiridakShANAM rUkShAmlaiH kaTukai rasaiH||128||
shuShkamUlakakaulatthairyUShaishcAnnAni bhojayet|
mAtulu~ggarasaM kShaudrapippalImaricAnvitam||129||
sanAgaraM pibet pittaM tathA~asyaiti svamAshayam|130|
</div></div>
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]
<div class="mw-collapsible mw-collapsed">
कटुतीक्ष्णोष्णलवणैर्भृशाम्लैश्चाप्युपक्रमः||१३०||
आपित्तरागाच्छकृतो [१] वायोश्चाप्रशमाद्भवेत्|
स्वस्थानमागते पित्ते पुरीषे पित्तरञ्जिते||१३१||
निवृत्तोपद्रवस्य स्यात् पूर्वः कामलिको विधिः|१३२|
<div class="mw-collapsible-content">
kaṭutīkṣṇōṣṇalavaṇairbhr̥śāmlaiścāpyupakramaḥ||130||
āPittarāgācchakr̥tō [1] vāyōścāpraśamādbhavēt|
svasthānamāgatē pittē purīṣē Pittarañjitē||131||
nivr̥ttōpadravasya syāt pūrvaḥ kāmalikō vidhiḥ|132|
kaTutIkShNoShNalavaNairbhRushAmlaishcApyupakramaH||130||
ApittarAgAcchakRuto [1] vAyoshcAprashamAdbhavet|
svasthAnamAgate pitte purIShe pittara~jjite||131||
nivRuttopadravasya syAt pUrvaH kAmaliko vidhiH|132|
</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]
=== ''Haleemaka'' (obstructive jaundice) ===
<div class="mw-collapsible mw-collapsed">
यदा तु पाण्डोर्वर्णः स्याद्धरितश्यावपीतकः||१३२||
बलोत्साहक्षयस्तन्द्रा मन्द्राग्नित्वं मृदुज्वरः|
स्त्रीष्वहर्षोऽङ्गमर्दश्च श्वासस्तृष्णाऽरुचिर्भ्रमः||१३३||
हलीमकं तदा तस्य विद्यादनिलपित्ततः|१३४|
<div class="mw-collapsible-content">
yadā tu pāṇḍōrvarṇaḥ syāddharitaśyāvapītakaḥ||132||
balōtsāhakṣayastandrā mandrāgnitvaṁ mr̥dujvaraḥ|
strīṣvaharṣō'ṅgamardaśca śvāsastr̥ṣṇā'rucirbhramaḥ||133||
halīmakaṁ tadā tasya vidyādanilaPittataḥ|134|
yadA tu pANDorvarNaH syAddharitashyAvapItakaH||132||
balotsAhakShayastandrA mandrAgnitvaM mRudujvaraH|
strIShvaharSho~a~ggamardashca shvAsastRuShNA~arucirbhramaH||133||
halImakaM tadA tasya vidyAdanilapittataH|134|
</div></div>
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'' ===
<div class="mw-collapsible mw-collapsed">
गुडूचीस्वरसक्षीरसाधितं माहिषं घृतम्||१३४||
स पिबेत्त्रिवृतां स्निग्धो रसेनामलकस्य तु|
विरिक्तो मधुरप्रायं भजेत् पित्तानिलापहम्||१३५||
द्राक्षालेहं च पूर्वोक्तं सर्पींषि मधुराणि च|
यापनान् क्षीरबस्तींश्च शीलयेत्सानुवासनान्||१३६||
मार्द्वीकारिष्टयोगांश्च पिबेद्युक्त्याऽग्निवृद्धये|
कासिकं चाभयालेहं पिप्पलीं मधुकं बलाम्||१३७||
पयसा च प्रयुञ्जीत यथादोषं यथाबलम्|१३८|
<div class="mw-collapsible-content">
guḍūcīsvarasakṣīrasādhitaṁ māhiṣaṁ ghr̥tam||134||
sa pibēttrivr̥tāṁ snigdhō rasēnāmalakasya tu|
viriktō madhuraprāyaṁ bhajēt pittānilāpaham||135||
drākṣālēhaṁ ca pūrvōktaṁ sarpīṁṣi madhurāṇi ca|
yāpanān kṣīrabastīṁśca śīlayētsānuvāsanān||136||
mārdvīkāriṣṭayōgāṁśca pibēdyuktyā'gnivr̥ddhayē|
kāsikaṁ cābhayālēhaṁ pippalīṁ madhukaṁ balām||137||
payasā ca prayuñjīta yathādōṣaṁ yathābalam|138|
guDUcIsvarasakShIrasAdhitaM mAhiShaM ghRutam||134||
sa pibettrivRutAM snigdho rasenAmalakasya tu|
virikto madhuraprAyaM bhajet pittAnilApaham||135||
drAkShAlehaM ca pUrvoktaM sarpIMShi madhurANi ca|
yApanAn kShIrabastIMshca shIlayetsAnuvAsanAn||136||
mArdvIkAriShTayogAMshca pibedyuktyA~agnivRuddhaye|
kAsikaM cAbhayAlehaM pippalIM madhukaM balAm||137||
payasA ca prayu~jjIta yathAdoShaM yathAbalam|138|
</div></div>
Patients suffering from ''haleemaka'' should take the recipe prepared from buffalo ghee by adding the juice of ''guduchi'' and milk.
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.
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 ===
<div class="mw-collapsible mw-collapsed">
तत्र श्लोकौ-
पाण्डोः पञ्चविधस्योक्तं हेतुलक्षणभेषजम्||१३८||
कामला द्विविधा तेषां साध्यासाध्यत्वमेव च|
तेषां विकल्पो यश्चान्यो महाव्याधिर्हलीमकः|
तस्य चोक्तं समासेन व्यञ्जनं सचिकित्सितम्||१३९||
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tatra ślōkau-
pāṇḍōḥ pañcavidhasyōktaṁ hētulakṣaṇabhēṣajam||138||
kāmalā dvividhā tēṣāṁ sādhyāsādhyatvamēva ca|
tēṣāṁ vikalpō yaścānyō mahāvyādhirhalīmakaḥ|
tasya cōktaṁ samāsēna vyañjanaṁ sacikitsitam||139||
tatra shlokau-
pANDoH pa~jcavidhasyoktaM hetulakShaNabheShajam||138||
kAmalA dvividhA teShAM sAdhyAsAdhyatvameva ca|
teShAM vikalpo yashcAnyo mahAvyAdhirhalImakaH|
tasya coktaM samAsena vya~jjanaM sacikitsitam||139||
</div></div>
To sum up, the topics discussed in this chapter are:
*Five types of ''pandu'' along with the etiology, signs and symptoms; and treatment
*Two types of ''kamala'' and their curability as well as incurability
*Different varieties of ''kamala''
*''Haleemaka'', which is a serious disease along with its signs and symptoms; and treatment [138-139]
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इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने
पाण्डुरोगचिकित्सितं नाम षोडशोऽध्यायः||१४0||
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ityagnivēśakr̥tē tantrē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē
pāṇḍurōgacikitsitaṁ nāma ṣōḍaśō'dhyāyaḥ||140||
ityagniveshakRute tantre~aprApte dRuDhabalasampUrite cikitsAsthAne
pANDurogacikitsitaM nAma ShoDasho~adhyAyaH||16||
</div></div>
Thus ends the sixteenth chapter in [[Chikitsa Sthana]] dealing with the treatment of ''pandu roga'' in the work of Agnivesha which was redacted by Charaka and because of its unavailability was supplemented by Dridhabala [140]
== Tattva Vimarsha (Fundamental Principles) ==
*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''.
*Heart and circulatory system are involved in the pathogenesis of ''pandu'' which is presented at the sites of skin and [[mamsa dhatu]] (flesh).
*The specific features are observed as per the [[dosha]] dominance in pathogenesis.
*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]].
*Chronic ''pandu roga'' is incurable. The prognosis depends upon involvement of [[dhatu] and its intensity.
*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]].
*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.
*''Kamala'' is of two types: ''Koshtha-shaksha shrita'' and ''shakhashrita''. In ''koshtha-shakhashrita kamala'' there is excess increase in [[pitta]].
*In ''shakhashrita kamala'', [[pitta]] is obstructed by [[kapha]] and improperly circulated by [[vata]]. Therefore the treatment principles differ in both.
*In ''koshtha-shaksha shrita kamala'', mild purgation is administered with bitter drugs with a focus on pacification of[[pitta]].
*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.
*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.
*''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 ===
*[[Dosha]]: [[Pitta]] dominant three [[dosha]], sadhaka and ranjak [[pitta]], vyana and samana [[vata]], avalambak and kledaka [[kapha]]
*[[Dhatu]](vitiated factors): [[Rasa dhatu]], [[rakta dhatu]], [[mamsa dhatu]] and [[meda dhatu]]
*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
*Srotas involved :Rasavaha, Raktavaha
*Type of ''samprapti'' : ''Avarodha'' and ''kshaya''
*Basic principles of treatment: ''Shodhana'' (mainly [[virechana]]) and ''shamana'' (mainly [[pitta]] shamana) 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, chutneys 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, chaats, pakode, panipuri, chaaps, 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.<ref>Rai Shalini, Kar Anukul C. A review of role of psychological factors in the etiopathogenesis of Pandu roga with reference to iron deficiency anemia.Ayu,2016 Jan-March,31(1):18-21. </ref>
==== Iatrogenic factors ====
Improper administration of oleation therapy and [[Panchakarma]] procedures can lead to ''pandu''.
==== Pathophysiology ====
[[File:Pandu.png|500px|thumb]]
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 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 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 ====
'''Premonitory symptoms''': Palpitations, dryness, lack of sweating, fatigue.
'''Signs''': Decrease in complexion, strength, unctuousness and vitality are observed in ''pandu''.
Various features related to that are categorized below:
{| class="wikitable"
|-
! scope="col"| S.No.
! scope="col"| Signs
! scope="col"| Symptoms Manifested
|-
| 1
| ''Varnakshaya'' (depletion of complexion)
| Discoloration of skin, poor lustre, pallor, yellowish, dark yellow skin
|-
| 2
| ''Balakshaya'' (depletion of strength)
| Weakness, fatigue
|-
| 3
| ''Snehakshaya'' (depletion of unctuousness)
| Dryness, poor quality of tissues
|-
| 4
| ''Ojakshaya'' (depletion of vitality)
| Fearfulness, excess worries, impaired sensations, lack of concentration, poor appearance
|}
The following clinical features are observed in ''pandu''. The involvement of [[dosha]], dushya and channels are as given in the following table:
==== Signs ====
{| class="wikitable"
|-
! scope="col"| S.No.
! scope="col"| Signs
! scope="col"| [[Dosha]]
! scope="col"| ''Dushya''
! scope="col"| ''Srotas''
|-
| 1
| ''Dhatushaithilya'' (laxity of tissues)
| [[Pitta]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 2
| [[Dhatu]] gaurava (heaviness in tissues)
| [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 3
| ''Varnakshaya'' (poor complexion)
| [[Vata]], [[Pitta]]
| [[Rasa dhatu]],[[Rakta dhatu]]
| ''Rasavaha, Raktavaha''
|-
| 4
| ''Balakshaya'' (poor strength)
| [[Vata]],[[Pitta]]
| [[Rasa dhatu]], [[Rakta dhatu]]
| ''Rasavaha, Raktavaha''
|-
| 5
| ''Snehakshaya'' (depletion of unctuousness)
| [[Vata]], [[Kapha]]
| [[Rakta dhatu]], [[Meda dhatu]]
| ''Raktavaha, Medavaha''
|-
| 6
| [[Oja]]gunakshaya'' (depletion of vitality)
| [[Vata]], [[Pitta]]
| Sapta [[dhatu]]
| ''Saptadhatu vaha''
|-
| 7
| ''Raktalpata'' (poor quality and less blood)
| [[Pitta]]
| [[Rasa dhatu]], [[Rakta dhatu]]
| ''Rasavaha, Raktavaha''
|-
| 8
| ''Medalpata'' (poor quality and less fats)
| [[Vata]], [[Pitta]]
| [[Rakta dhatu]], [[Mamsa dhatu]]
| ''Raktavaha, Mamsavaha''
|-
| 9
| ''Nihasarta'' (poor quality tissues)
| Tri[[dosha]]
| Sapta[[dhatu]]
| ''Saptadhatu vaha''
|-
| 10
| ''Shithilendriya'' (impairment of senses)
| Tri[[dosha]]
| Sapta[[dhatu]]
| ''Rasavaha, Raktavaha''
|-
| 11
| ''Vaivarnya'' (discoloration)
| [[Pitta]]
| [[Rasa dhatu]],[[Rakta dhatu]], [[Mamsa dhatu]]
| ''Rasavaha, Raktavaha, Mamsavaha''
|-
| 12
| ''Panduta'' (pallor)
| [[Pitta]]
| [[Rasa dhatu]],[[Rakta dhatu]], [[Mamsa dhatu]]
| ''Rasavaha, Raktavaha, Mamsavaha''
|}
==== Symptoms ====
{| class="wikitable"
|-
! scope="col"| S.No.
! scope="col"| Symptoms
! scope="col"| [[Dosha]]
! scope="col"| ''Dushya''
! scope="col"| ''Srotas''
|-
| 1
| ''Karnakshweda'' (tinnitus)
| [[Vata]]
| [[Rakta dhatu]]
| ''Raktavaha''
|-
| 2
| ''Hatanala'' (poor digestion)
| [[Kapha]], [[Vata]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 3
| ''Daurbalya'' (weakness)
| [[Vata]], [[Pitta]]
| Sapta[[dhatu]]
| ''Rasavaha, Raktavaha''
|-
| 4
| ''Sadana'' (bodyache)
| [[Vata]], [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 5
| ''Annadwesha'' (anorexia)
| [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 6
| ''Shrama'' (overworked, fatigue)
| [[Vata]]
|[[Rasa dhatu]]
| ''Rasavaha''
|-
| 7
| ''Bhrama'' (vertigo)
| [[Vata]], [[Pitta]]
| [[Majja dhatu]]
| ''Majjavaha''
|-
| 8
| ''Gatrashoola'' (pain)
| [[Vata]]
| [[Rakta dhatu]], [[Mamsa dhatu]]
| ''Raktavaha, Mamsavaha''
|-
| 9
| ''Jwara'' (feverishness)
| [[Pitta]]
| [[Rasa dhatu]], Sweda
| ''Rasavaha, Swedavaha''
|-
| 10
| ''Shwasa'' (dyspnea)
| [[Vata]], [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha, Pranavaha''
|-
| 11
| ''Gaurava'' (heaviness)
| [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 12
| ''Aruchi'' (aversion to food)
| [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 13
| ''Mridit iv gatrata'' (kneading pain)
| [[Vata]]
| [[Rasa dhatu]], [[Rakta dhatu]], [[Mamsa dhatu]]
| ''Rasavaha, Raktavaha, Mamsavaha''
|-
| 14
| ''Pidita unmathit gatrata'' (churning, pressing pain)
| [[Vata]]
| [[Rasa dhatu]],[[Rakta dhatu]], [[Mamsa dhatu]]
| ''Rasavaha, Raktavaha, Mamsavaha''
|-
| 15
| ''Akshikutashotha'' (pre-orbital swelling)
| [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 16
| ''Harita lomata'' (greenish body hair)
| [[Pitta]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 17
| ''Shirnalomata'' (falling body hair)
| [[Vata]],[[Pitta]]
| [[Asthi dhatu]]
| ''Asthivaha''
|-
| 18
| ''Hatprabhatva'' (poor luster)
| [[Pitta]]
| [[Rakta dhatu]]
| ''Raktavaha''
|-
| 19
| ''Kopana'' (irritability)
| [[Pitta]]
| [[Rakta dhatu]]
| ''Raktavaha''
|-
| 20
| ''Shishiradwesha'' (disliking cold)
| [[Vata]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 21
| ''Nindraluta'' (excessive sleepiness)
| [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 22
| ''Sthivanadhikya'' (excessive sputum)
| [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|-
| 23
| ''Alpawaka'' (less speaking)
| [[Vata]]
| [[Rakta dhatu]]
| ''Raktavaha''
|-
| 24
| ''Pindikodweshtanam'' (pain in calf muscles)
| [[Vata]]
| [[Rakta dhatu]],[[Mamsa dhatu]]
| ''Raktavaha, Mamsavaha''
|-
| 25
| ''Katiurupadaruka Sadana'' (pain in legs, thighs, and the lumbar region)
| [[Vata]]
| [[Rasa dhatu]], [[Rakta dhatu]], [[Mamsa dhatu]]
| ''Rasavaha, Raktavaha, Mamsavaha''
|-
| 26
| ''Arohaneayasa'' (dyspnea on climbing)
| [[Vata]], [[Kapha]]
| [[Rasa dhatu]]
| ''Rasavaha''
|}
==== Differentiating features of ''dosha'' dominance ====
{| class="wikitable"
|-
! colspan="3"|Changes in color and texture manifested in the whole body and its parts
|-
! scope="col"| ''Vata'' dominant ''pandu''
! scope="col"| ''Pitta'' dominant ''pandu''
! scope="col"| ''Kapha'' dominant ''pandu''
|-
| Blackish or dark reddish discoloration of the skin, blood vessels, nails, face and eyes
| Yellowish discoloration of skin, the skin, blood vessels, nails, face and eyes
| Whitishness discoloration of skin, the skin, blood vessels, nails, face and eyes
|-
! colspan="3"|Features related to urine and stool
|-
| Blackish urine & stool, dry stools
| Yellowish colored urine & stool, foul smelling and loose stools
| Whitishness in the urine & stool
|-
! colspan="3"|Features related to ''agni''
|-
| Tastelessness in the mouth
| Pungent taste in mouth
| Sweet taste in the mouth
|-
| rowspan="6"|Abdominal distension
| Does not relish food
| Anorexia
|-
| rowspan="2"|Improper digestion of food
| Heaviness
|-
| Excessive salivation
|-
| Sour Eructation
| Laziness
|-
| Eructation associated with burning sensation
| rowspan="2"| Vomiting
|-
| Burning Sensation
|-
! colspan="3"|Other features
|-
| Pain in the body, pricking pain
| Increased body temperature
| Drowsiness
|-
| Tremor
| Excessive thirst
| Horripilation
|-
| Headache
| Fainting due to excessive thirst/coma
| Mental fatigue
|-
| Weakness
| Profuse sweating
| Fainting
|-
| Pain in the sides of the chest
| rowspan = "2"| Weakness
| Prostration
|-
| Giddiness
|Inability to speak
|-
| Swelling/Edema
| Feeling of darkness in front of eyes
| Cough, Dyspnea, Edema
|-
! colspan="3"|Likings and Dislikings
|-
|
| Longing for cold things and environment
| Likings for pungent items
|-
|
| Dislike for hot food and atmosphere; also, do not suit the patient
| Likings for ununctuous things
|-
|
| Dislike for sour food; also, do not suit the patient
| Likings for hot things
|}
==== Consequences of [[dhatu]] kshaya ====
{| class="wikitable"
|-
! scope="col"| S.No.
! scope="col"| Pathological event
! scope="col"| Consequence
! scope="col"| Objectivity
|-
| 1
| [[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 dhatu]] kshaya
| 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 dhatu]] kshaya
| 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 dhatu]] kshaya
| 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"
|-
! scope="col"| S.No.
! scope="col"| Signs and Symptoms
! scope="col"| Diseases
|-
| 1
| Blackish discoloration of the skin
| Megaloblastic anemias (Vitamin B12 and folic acid deficiency) as reversible melanin skin hyperpigmentation which develops mainly over the knuckles
|-
| 2
| Reddish discoloration of body parts
| Development of petechiae, echymosis or bruises on the body due to thrombocytopenia associated with anemia (as in Aplastic anemias). Anemia due to Addison’s disease (increased tanning)
|-
| 3
| Dry skin or body
| Megaloblastic anemias due to the abnormal proliferation of epithelial cell surfaces. Anemia due to hypothyroid states
|-
| 4
| Reddish or Blackish discoloration in eyes, face and nails
| Body parts due to spontaneous bleeding manifestations, pernicious anemia
|-
| 5
| Blackish urine
| Cola colored urine in various types of intravascular hemolytic anemias when the plasma hemoglobin exceeds the haptoglobin binding capacity
|-
| 6
| Blackish stool/melena
| Gastrointestinal bleeding responsible for anemias - may be due to any ulcers or worm infestations or any other cause
|-
| 7
| Dryness of stool or constipation
| Megaloblastic anemias and anemia due to hypothyroidism
|-
| 8
| "Pins and needles" sensation
| pernicious anemias as well as in megaloblastic anemias
|-
| 9
| Tremors
| Cobalamin deficiency which causes peripheral neuropathy and degeneration of the posterior and pyramidal tracts of the spinal cord
|-
| 10
| Loss of taste/distaste
| Pernicious anemia
|-
| 11
| Bodyache
| Hemolytic anemia, hypothyroidism
|}
The observations of resemblance with diseases in conventional system of medicine show that all types of anemia specially megaloblastic anemia, pernicious anemia, hypothyroidism, haemolytic anemia can be considered under umbrella of ''pandu''. The objective parameters used for these disorders can be utilized for research on efficacy of [[Ayurveda]] therapies in management of ''pandu''.
=== ''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)
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'' ====
==== 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.
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'') ====
''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.
=== ''Haleemaka'' ===
''Haleemaka'' is a further stage of ''pandu''. Reduced oxygen carrying capacity of blood (reduced ''jeevan karma'') causes depletion of strength and work capacity. This further leads to lack of libido and bodyache. Condition resembles cholestasis. Bile stasis and back pressure leads to liver failure which leads to the further symptoms of ''halimaka'' or sclerosing cholangitis. It is characterized by severe fatigue (''bala utsaha hani''), jaundice (''harita pita meda''), dark urine, cirrhosis, portal hypertension and hepato-megaly.
=== ''Panaki'' ===
''Panaki'', another disease in same context of ''halimaka'', explains the condition of malabsorption especially of fat due to lack of bile juice in digestion due to obstruction which leads to steatorrhoea (''bhinna varcha''). Reduced fat absorption leads to deficiency of fat soluble vitamins such as A, D, E and K.
=== ''Kumbha Kamala'' ===
The description of ''kumbha kamala'' denotes the advanced stage of ''Kostha-shakhasrita kamala'' wherein the main seat of pathology is situated somewhere in the gastro-intestinal tract. ''Kumbha'' is one of the synonyms of ''koshtha''. Edema is described as one of the important clinical features of ''kumbha kamala'' (Su. Utt. 44).
Both types of ''kamala'', if not treated convert into difficult to treat and hardened skin. ''Kumbha kamala'' could also refer to the presentation of the patient having distended abdomen i.e. ascitis, which is one of the important clinical feature of liver diseases, which are also the main cause of jaundice.
Liver is the main seat for a number of functions and when it gets severely deranged the liver functions are affected. The clinical picture of ''kumbha kamala'' corresponds to these as observed below:
*The production of majority of proteins as albumin, few globulins, cerulo-plasmin etc., is hampered leading to edema in the various body parts (''Bhrusham Shoonam cha Manavaḥ'') and dryness in the body.
*The coagulation profile gets affected leading to increased prothrombin time, the presentation of esophageal varices, bleeding per rectum etc. Here the same features have been described as ''sarakta akshi mukha, chhardi vida mootra'' meaning blood seen or coming out of the eyes, mouth or in the vomitus (esophageal varices), through the stool (haemorrhoids) or through the urine.
*The derangement of liver structure in these diseases leads to some presentation of obstructive jaundice with yellow urine (''peeta mootrata'').
*The stage of altered consciousness has also been described as ''tandra moha samanvita'' (acting as if sleepy or having altered perception - semiconscious state).
*The stage of hepatic coma has also been described as ''nashta sangya'' means the person is not able to recognise and perceive anything – unconscious state (''Sangya Nama Grahanena'').
*The excessive dryness (''kharibhuta'') is generally due to increased bile salts deposition leading to pruritus and dryness of skin. This dryness further leads to the hardness.
*As liver disorders progress, coagulatory defects begin leading to upper G.I. track bleed causing black stools/''malena''(''Krishna shakrita''). Secondly conjugated bilirubin which does not enter intestine becomes urobilinogen giving urine dark color (''krishna mutra'').
*Excessive edema is observed all over body. Cirrhosis of the liver is a condition that causes reduction in plasma protein concentration. Cirrhosis means development of large amounts of fibrous tissue among the liver parenchymal cells. One result is failure of these cells to produce sufficient plasma proteins, leading to decreased plasma colloid osmotic pressure and the generalized edema that goes with this condition. Another way that liver cirrhosis causes edema is that the liver fibrosis sometimes compresses the abdominal portal venous drainage vessels as they pass through the liver before emptying back into the general circulation. Blockage of this portal venous outflow raises capillary hydrostatic pressure throughout the gastrointestinal area and further increases filtration of fluid out of the plasma into the intra-abdominal areas. When this occurs, the combined effects of decreased plasma protein concentration and high portal capillary pressures cause transudation of large amounts of fluid and protein into the abdominal cavity, a condition referred to as ascites.
*Hematemesis/bleeding in eyes,per rectum, hematuria (''Sarakta akshi mukha chhardi vinamutra'') explains the bleeding disorders which begin in late hepatic disorders.
*Fainting (''tamah pravesha'') is due to reduced cerebral perfusion due to various causes like gastrointestinal bleed, electrolyte or metabolic disturbance.
*Drowsiness (''tandra''), confusion (''moha'') are further symptoms of hepatic encephalopathy. Neuropsychological findings are experienced in all phases of hepatic encephalopathy. It is experienced as forgetfulness, mild confusion and irritability, inversed sleep pattern followed by lethargy and personality changes. The third stage is marked with worsened confusion and in fourth stage is coma. ''Mada, Murchha'' and ''sanyasa'' are mentioned earlier as disorders due to vitiated blood in [[Vidhishonitiya Adhyaya]].
==== Śākhāśrita kāmala (kamala in body tissue with obstructive pathology) ====
=== Management of Diseases (Treatment Protocols) ===
==== Current clinical practices in treatment of ''pandu'' and ''kamala'' ( referred from Chikitsa Pradeep) ====
{| class="wikitable"
|-
! scope="col"| Type
! scope="col"| Medicine
! scope="col"| Dose
! scope="col"| Time
! scope="col"| ''Anupana''
|-
|rowspan = "3"|[[Vata]] dominant ''pandu''
| ''Mahayogaraja samira mixture''
| 120-480 mg
| After meals
| Ghee (''dadimadi'') + honey
|-
| ''Tiktaka ghritam''
| 10-40 ml
| After meals
| Hot water
|-
| ''Navajivana rasa''
| 120-200 mg
| After meals
| Milk
|-
| rowspan = "2"|[[Pitta]] dominant ''pandu''
| ''Tapyadi lauha'' mixture
| 250 - 600 mg
| After meals
| Dadimadi ghee + udumbaravaleha
|-
| ''Vasadi'' decoction
| 20 - 40 ml
| After meals
| Honey
|-
| [[Kapha]] dominant ''pandu''
| ''Gomutra Haritaki'' mixture
| 600 mg - 3 grams
| After meals
| Honey + juice of castor leaves
|-
| ''Mrittika bhakshana janya''
| ''Gomutra Haritaki'' mixture
| 600 mg - 3 grams
| After meals
| ''Kumari Asava''
|-
| rowspan="2"|''Riddha Patha Kamala''
| ''Ichha bhedi rasa''
| 120 - 180 mg
| Early morning one time
| Lemon juice
|-
| ''Suta shekhara kalpa''
| 120 - 250 mg
| After meals
| Milk + sugar
|-
| ''Koshtha ashrita kamala''
| colspan="4"|As like ''pitta'' dominant ''pandu''
|}
==== Treatment of sākhāśriat kamala ====
==== 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>
*''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>
=== Research studies on ''pandu'' ===
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'':
#Sarkar PK, Prajapati PK, Choudhary AK, Shukla VJ, Ravishankar B. Haematinic Evaluation of Lauha Bhasma and Mandura Bhasma on HgCl2-induced Anemia in Rats. Indian J Pharm Sci 2007;69:791-5.
#Sarkar PK. A Comparative Pharmaceutico-pharmaco-clinical study of Lauha Bhasma and Mandura Bhasma w.s.r. to its Pāndu-hara Effect, MD thesis. I.P.G.T. & R.A. Jamnagar: Gujrat [[Ayurveda]] University; 2005.
#Garai A, Rai M, Kumar A. Role of an Ayurvedic Compound (Panduhara Yoga) in the Management of Iron Deficiency Anaemia in Children. Ayu 2009;30:469-74.
#Gupta V, Reddy KR. Experimental Studies of Lohasava. Aryavaidyan 2007;21:87-94.
#Sarkar PK, Prajapati PK, Shukla VJ, Ravishankar B, Choudhary AK. Toxicity and recovery studies of two Ayurvedic preparations of iron. Indian J Exp Biol 2009;47:987-92.
#Devarshi P, Kanse A, Kanse R, Mane S, Patil S, Varute AT. Effect of Mandura Bhasma on lipolytic Activities of Liver, Kidney and Adipose Tissue of Albino Rat During CCl4 Induced hepatic Injury. J Biosci 1986;10:227-34.
#Pandit S, Biswas TK, Debnath PK, Saha AV, Chowdhury U, Shaw BP, et al. Chemical and pharmacological evaluation of different Ayurvedic preparations of iron. J Ethnopharmacology 1999;65:149-56.
#Dinesh C. Sharma, Deepa Chandiramani, Manminder Riyat and Praveen Sharma. Scientific evaluation of some ayurvedic preparations for correction of iron deficiency and anemia. Indian Journal of Clinical Biochemistry, 2007 / 22 (2) 123-128
#Ambika Das, PA03.17. A clinical evaluation of Punarnavadi Mandura and Dadimadi Ghritha in management of Pandu (Iron defeciency anaemia), Ancient Science of Life 2013; 32 (s2):86
One of the studies (Sharma D.C, 2007) report that the Ayurvedic preparations were found equally effective as the allopathic compound in the management of iron deficiency anemia and the fact that the side effects were almost nil establishes them to be even superior.
The modes of action of drugs and procedures as stated in this chapter, which is without iron, have not been studied much in anemia. Though, some of the preparations described in anemia have been found very useful in the management of other types of anemia as sickle cell anemia,<ref>Macmillan Keith, A herbomineral composition for the treatment of Sickle Cell disease. Retrieved from tgs.freshpatents.com</ref> aplastic anemia,<ref>Subhash singh, Shiv Kumar Singh and Narendra Kumar Singh. Aaplastic anaemia, complete cure, ayurvedic way – case report. International Journal Of Basic And Applied Medical Sciences Issn: 2277-2103 (Online) An Online International Journal Available At http://www.cibtech.org/jms.htm 2013 vol. 3 (1) january-april, pp.242-246/subhash et al.</ref> etc.
So, further studies need to be done in order to know the efficacy of these drugs and mechanisms in the various types of anemia.
==== Summary ====
=== Principle of treatment for ''kamala'' ===
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>
=== List of Research Works done ===
=== Tattva Vimarsha ===
=== IPGT&RA, Jamnagar ===
#Chaudhary sudhakar (1958): Pandu Roga Nidana.
#Mishra N. K. (1959): A clinical study of Pandu Roga.
#Bhattacharya R. C. (1965): Pandu Roga Par Paradamruta Teekshana Laugh Karyanvekshana
#Ojha N.H.(1966): Abhraka Bhasma Ka Pandu Roga Par Karyanvekshana.
#Pillai K.D.R. (1974): Study of effect of Swarna Makshika Bhasma on Pandu.
#Jha Prabhakar (1974): Swayama Lauha Bhasma Ka Pandu Roga Par Kriyatamaka Adhyayana.
#Sharada B.D.(1975) : Effect of Yogaraja on Garbhavasthajanya Pandu.
#Gopalkrishana (1986): Lauha Bhasma on Pandu with special reference to its Media.
#M.S.Trivedi (1992): Effect of Yogaraja Rasayana in Garbhavsthajanya Pandu.
#Nargunde Rajeshri (1997): A comparative Phaemaco-clinical Study of Shudha Kasisa Churna and Kasisa Bhasma on PANDU.
#Jain Sangeeta (2000): A study on Pandu Roga w.s.r. to ANAEMIA and Its Management with Shodhana and Yogaraja Rasayana.
#Sarkar P K (2005): A comparative pharmaco-pharmaceutico Clinical study of lauha bhasma and mandura bhasma w.s.r. to Panduhara effects.
=== Vidhi Vimarsha ===
=== Banaras Hindu University, Varanasi ===
#Trivedi R D (1979):Hematological and clinical stubby in pandu.
#Malhotra E. N. (1983): Management of Garbhavasthajnya Pandu with Mandura Bhasma.
#Nandkishore (1985): Clinical Assessment of Navayasa Lauha in Management of Pandu.
#Chauhana A. P. S. (1985): Role of Manduradi Ghanvati in Pandu Roga.
#Dixit A. K. (1994): Clinical study in Yogaraja Rasayana on Pandu.
#Singh S. N. (1996): A study on aetio pathogenesis of Pandu Roga w s r to its Samprapti Vighatan by Makshika.
#Agrawal N. Assessment of Effect of Mandura Bhasma in Iron Deficiency Anemia in Children, MD thesis. P.G. Department of Kaumarbhritya. Varanasi: IMS, B.H.U; 2007.
=== Research studies on pandu ===
=== National Institute of [[Ayurveda]], Jaipur and others ===
#Tyagi R. M. (1980): Pandu Roga Evam Vajra Vatak Mandura .
#B. C. Sharma (1985): Pandu Roga Samprapti Vivechana.
#R. K. Sharma (1994): Pandu Roga Mandura Bhasma Ka Chikitsatmaka Adhyayan.
#Meena R. K. (1994): Guduchi in Pandu Roga.
#Joshi N. (2005): Pharmaceutical, Pharmacological and Toxicological Study of Various Lauha Preparations(Kalpa) w.s.r. to Iron Deficiency Anaemia, M.D. Thesis. P. G. Department of Rasa Shastra and Bhaishajya Kalpana, Jaipur.
#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.
=== Potential areas /scope for further research ===
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:
#''Dadimadya ghritam''
#''Katukadyam ghritam''
#''Pathyaghritam''
#''Danti ghritam''
#''Drakshaghritam''
#''Haridradi ghritam''
#''Darvyadi ghritam''
#''Navayasa churnam''
#''Manduravataka''
#''Tapyadi lauha''
#''Yogaraja''
#''Punarnava Mandura''
#''Darvyadi leha''
#''Dhatryavaleha''
#''Manduravatakah''
#''Gaudo arishah''
#''Bijakarisha''
#''Dhatryarishta''
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References
== References ==
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