Introduction

The Dosha, Dhatu and Mala are basis [Moola] of body, which are responsible for all physiological processes in body. Vitiation of Pitta predominant Tridosha initiates pathological processes in body and causes Pandu Roga.^[1] In this condition, vitiated Pitta afflicts Dhatus as a result complexion, strength, unctuousness gets too much diminished due to morbidity of Dosha and dushya and as a result blood, fat and Ojas gets exceedingly reduced.^[2] Acharya Charaka has included Pandu Roga in Rasapradoshaj Vikara^[3] and Santarpana Janya Vyadhi.^[4] Also Vachaspatya refers Pandu as color of patient resembles with colour of pollen grains of Ketaki flower which is whitish yellow [pale] in appearance.^[5] It is characterized by clinical features such as Panduta [pallor], Daurbalya [general debility], Angsaad [weakness of body], Annadwesha [aversion towards food], Shrama [fatigue], Bhrama [giddiness], Gatrashoola [bodyache], Aruchi [anorexia], Hataanala [poor digestion], Akshikoota Shotha [swelling over peri-orbital area].^[6] Pandu is a symptom as well as disease and mostly resembles with anaemia of modern science. Anaemia word is derived from Greek word ‘Anaimia’. ‘An’ means without and ‘Haima’ means blood.^[7] According to modern science, Anaemia is deficiency of haemoglobin in blood which can be caused by either few red blood cells [RBCs] or too little Haemoglobin in cells.^[8] Nutritional deficiency anaemia is very common in India and Iron deficiency is commonest nutritional deficiency all over world, but its prevalence is higher in developing countries like India. It most commonly affects children and females of reproductive age group. In India, prevalence of anaemia is 52%. WHO estimates that nearly 1/3^rd of world’s population is suffering from Anaemia. The data of National family health survey-3 shows that Anaemia is particularly high [55.3%] in all women of 15-49 years age group.^[9] Its causes mainly include poor vegetarian diet, malabsorption of iron, hookworm infections, excessive blood loss, menstruation and childbirth. Its symptoms resembles with Pandu Roga which include fatigue, weakness, dizziness and shortness of breath.

Through this article, an attempt has been made to review various available classical Ayurvedic texts to find out different description about Pandu Roga w.s.r. to Iron deficiency Anaemia.

Garuda Purana and Agni Purana contain descriptions of Pandu Roga. In Mahabharata, Pandu was described as the father of Panch Pandava and as the son of Maharshi Ved Vyasa. In Garuda Purana, there is a reference in which "Takra" mixed with Lauha Churna has been advocated for the treatment of Pandu. This shows that Pandu Roga was prevalent in that period and physicians were able to diagnose and treat it. It is therefore apparent that the use of Iron preparation for the treatment of Pandu Roga was well known since ancient times.

Detailed description of Pandu Roga is given in most of the Ayurvedic literature, which is hereby summarized as under-

Nidana^[22,23]

Nidana of Pandu Roga can be broadly classified into 3 groups as per various classical texts- (Charaka Chikitsa 16/8; Sushruta Uttarsthana 44/3]

1. Aaharaja Nidana
2. Viharaja Nidana
3. Nidanarthakara Roga

1) Aaharaja Nidana

Acharya Charaka has described following etiological factors regarding Ahara:

• Excess intake of Kshara (alkaline), Amla (sour), Lavana (salt), Ushna (hot) and Teekshna (penetrating) Ahara
• Virudhha (incompatibles) and Asatmya (unwholesome) Ahara
• Excessive intake of Nishpava, Masha, Pinyaka and Til Taila.

2. Shthivana (salivation)
3. Gatrasada (sense of lassitude in the limbs)
4. Mridbhakshanam (liking for mud intake)
5. Prekshankootsothhah (swelling over eye socket)
6. Vid-Mutra Pitata (yellow colour of stool-urine)
7. Avipaka (Indigestion)

Acharya Harita has mentioned Panduta in the Purvaroopa of Pandu Roga

Roopa / Lakshana

Acharya Charaka has mentioned the Samanya and Vishesha Lakshana of Pandu Roga in Chikitsa Sthaan according to the Dosha involvement which is mentioned below-

Its symptoms include

1. Bala-Varna-Agni Nash (loss of strength, complexion and power of digestion metabolism)
2. Ganda-Akshikuta-Bhrupad-Nabhi-Mehan Shotha (oedema on cheek, orbital region, eyebrow, feet, umbilical region, genital parts)
3. Krimi Koshta (Appearance of intestinal worm)
4. Atisaryet Mala Sasruka Kapha (diarrhoea associated with blood and mucus).

Samprapti^[29]

When Doshas, with Pitta as most predominant one, are aggravated in Dhaatus, then Dhaatus get afflicted, with result that they become Shithila (weak) and Guru (heavy). Thereafter, complexion, strength and unctuousness and properties of Ojas gets exceedingly reduced on account of vitiation of Doshas and Dhaatus. So, patient becomes poor in blood, fat and vitality; his sense organs become weak; and he suffers from discoloration. Aggravation of Pitta located in Hridaya (cardiac region) takes place due to its exciting causes, then this Pitta being forcefully propelled by Vaayu, enters into ten vessels and circulates in entire body. Being located between skin and muscle tissue, this aggravated Pitta vitiates Kapha, Vaayu, Asrik (blood), skin and muscles as a result different types of coloration, like Pandu (pale yellow), Haridra (yellow) and Harita (green) appearance of skin. This is called Pandu Roga.

Samprapti Chakra^[30]

Tridosha Prakopaka Ahara-Vihara (Pitta Pradhan)
↓
Aggravation of Sadhak Pitta located in Hridaya
↓
Expelled from Hridaya by powerful Vata Dosha
↓
Enters Dasha-Dhamaniya & circulates all over body
↓
Causes Rasavaha Strotasa Dushti
↓
Dushti of Twaka, Rakta, Mansa
↓
Ashraya of Dosha between Twaka and Mansa
↓
Awrodha to Bhrajaka Pitta
↓
Expressions of various Varnas on Twacha
↓
Pandu

• Hence to bring the Doshas in Koshtha and to correct Rukshata, both Abhyantar and Bahya Snehana is essential in Pandu Rogi. For Abhyantar Snehana, Acharya Charaka has indicated some medicated ghee like Panchagavya Ghrit, Mahatiktaka Ghrit, Kalyanaka Ghrit
• Vaman and Virechana Karma: After bringing Doshas in Koshtha by Samyak Snehana and Swedana, the Doshas are expelled out of the body by the action of Vaman and Virechana Karma.
  
  For Pitta Dosha, Virechana is considered as the best Shodhanopkrama, Hence Virechana is most suitable in Pandu Roga.
• Vishesha Chikitsa

Pathya-Apathya

1. Pathya Ahara

According to Acharya Charaka^[35]

• Shalianna, Yava, Godhuma mixed with Yusha prepared from Mudga, Adhaki and Masura
• Jangal Mamsa Rasa

According to Acharya Sushruta^[36]

• Pandu Rogi must use Arishta prepared from Guda, Sharkara (sugar) and Madhu (honey)
• Asava prepared from Mutra and Kshara
• Jangala Mamsa Rasa added with Sneha (fat) and Amalaki Swarasa

2. Apathya Ahara and Vihara^[37]

In Bhaisajya Ratnavali following Apathya Aahar-Vihara are mentioned

• Rakta Sruti, Dhoompan, Vaman Vega Dharan, Swedan and Maithoon
• Avoid consumption of Shimbi, Patrashaak, Ramath, Masha, Ambupaan, Pindyaak, Tambul, Sarshapa, and Sura
• Intake of water of rivers like those originating from Vindhya and Sahyadri Mountains
• All types of salt, sour edibles, Virudhha Anna (incompatible foods), food that is Guru (heavy to digest) and Vidahi (cause a burning sensation).

Discussion

Pandu Roga, as described in classical Ayurvedic texts, is disorder characterized by pallor of skin, fatigue, weakness & mental dullness, which bears striking resemblance to iron-deficiency anaemia as understood in contemporary medical science. However, Ayurvedic perspective provides more holistic view, attributing condition not only to nutritional deficiencies but also to imbalances in doshas, particularly Pitta & Rakta Dhatu.

not only in improving haemoglobin levels but also in enhancing overall vitality and quality of life. Therefore, a physician must have complete knowledge of different aspects of Pandu Roga like Vyutpatti, Nirukti, Paribhasha, Paryaya, Prakara, Nidana, Poorvaroopa, Roopa, Samprapti, Sadhyaasadhytwa, Chikitsa, Pathyaapathya from various Ayurvedic texts and other literatures for better management of patients.

References