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{{#seo:

|title=Pandu Chikitsa

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|keywords=Pandu roga, kamala, koshthashakhashrita kamala, shakhashrita kamala, panaka, kumbhakamala, haleemaka, anemia, jaundice,Ayurveda, Indian system of medicine, charak samhita.

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|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

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|type=article

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

{{Infobox

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

|label6 = Translator and commentator

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|data6 = Kar A.C.,Rai S., Aladoriya N., Deole Y. S.

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|data6 = Kar A.C., Rai S., Aladoriya N., [[Yogesh Deole|Deole Y. S.]]

|label7 = Reviewer

|data7 = Ojha S.N.

|label8 = Editors

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|data8 = Singh G., Goyal M., Deole Y.S., Basisht G.

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|data8 = Singh G., Goyal M., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication

|data9 = 2020

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

}}

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

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<~~div~~ style="text-align:justify;">

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<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.

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

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<br/>

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

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

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</p>

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</~~div~~>

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

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

{| class="wikitable"

|-

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| 1

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| ''Rasa kshaya''

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| [[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

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| ''Rakta kshaya''

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| [[Rakta dhatu]] kshaya

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

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| 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

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| ''Mamsa kshaya''

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| [[Mamsa dhatu]] kshaya

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

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| 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

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| ''Meda kshaya''

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| [[Meda dhatu]] kshaya

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

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| 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

|}

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

{| class="wikitable"

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=== ''Kamala'' ===

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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)

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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''.

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

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

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

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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.

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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.

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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.

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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.

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

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==== 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.

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

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

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

| ''Mahayogaraja samira mixture''

| 120-480 mg

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| Milk

|-

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

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

| ''Tapyadi lauha'' mixture

| 250 - 600 mg

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| Honey

|-

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

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

| ''Gomutra Haritaki'' mixture

| 600 mg - 3 grams

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

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*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>

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*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>

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*''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>

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

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

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

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== Research studies on ''pandu'' ==

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=== 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'':

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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>

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== List of Research Works done ==

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=== List of Research Works done ===

=== IPGT&RA, Jamnagar ===

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#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.

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== Potential areas /scope for further research ==

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=== 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:

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#''Bijakarisha''

#''Dhatryarishta''

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<big>'''[[Special:ContactMe|Send us your suggestions and feedback on this page.]]'''</big>

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