smear in different types of doshaja pandu roga

i

“A STUDY ON THE DIAGNOSTIC VALUE OF PERIPHERAL BLOOD

SMEAR IN DIFFERENT TYPES OF DOSHAJA PANDU ROGA”

BY

Dr. SHIVANI KAUNDAL B.A.M.S

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bengaluru

In partial fulfillment of the requirements for the degree of

“AYURVEDA VACHASPATI”

DOCTOR OF MEDICINE(AYURVEDA)

In ROGANIDANA

GUIDE

Dr. VENKATESHA S M.D.(Ayu)

Reader & HOD Department of P.G. Studies in Roganidana

JSS Ayurveda Medical College. Mysuru

DEPARTMENT OF POST GRADUATE STUDIES IN ROGANIDANA JSS AYURVEDA MEDICAL COLLEGE MYSURU – 570028

2017 – 2018

ix

ABBREVIATIONS

Ch – Charaka Samhita

Chi – Chikitsa sthana

Vi – Vimana sthana

Su – Sushruta Samhita

Ut – Uttara tantra

A.H – Ashtanga Hrudaya

Ni – Nidana sthana

B.P – Bhavaprakasha

Y.R – Yogaratnakara

M.N – Madhava Nidana

G.N - Gada Nigraha

x

LIST OF TABLES

SL NO. HEADING PAGE NO.

1 Classification of Pandu roga 9

2 Aharaja nidana 11-12

3 Viharaja nidana 13

4 Manasika nidana 14

5 Nidana with effect on dosha- dushya 14-15

6 Samanya lakshana 20-21

7 Samanya lakshanas with Amshmsha kalpana 22-24

8 Vataja Pandu lakshana 24-26

9 Pittaja Pandu lakshana 26-27

10 Kaphaja Pandu lakshana 28-29

11 Tridoshaja Pandu lakshana 29-30

12 Upadrava of Pandu roga 44

13 Distribution of Subjects according to Age 61

14 Distribution of subjects according to the Gender 62

15 Distribution of subjects according to the Locality 63

16 Distribution of subjects according to the religion 64

17 Distribution of subjects according to the marital

status 65

18 Distribution of subjects according to the

educational status 66

19 Distribution of subjects according to the Socio 67

xi

economic status

20 Distribution of subjects according to the Diet 68

21 Distribution of subjects according to the appetite 69

22 Distribution of subjects according to the night sleep

70

23 Distribution of subjects according to the day sleep 71

24 Distribution of subjects according to the bowel

(consistency) 72

25 Distribution of subjects according to the tea

consumption 73

26 Distribution of subjects according to the type of

employment 78

27

Distribution of subjects according to the nature of

cycles

79

28 Distribution of subjects according to the Quantity 80

29 Distribution of subjects according to the

nourishment 82

30 Distribution of subjects according to the nadi 83

31 Distribution of subjects according to the Sparsha 84

32 Distribution of subjects according to the Akruti 85

33 Distribution of subjects according to the Prakruti 86

34 Distribution of subjects according to the Pramana 87

35 Distribution of subjects according to the satva 90

36 Distribution of subjects according to the 91

xii

Abhyavarana Shakti

37 Distribution of subjects according to the Jarana

shakti 92

38 Distribution of subjects according to the Vyayama

shakti 93

xiii

LIST OF FIGURES

LIST OF GRAPHS

SL NO. Graph name Page no.

1 Distribution of patients based on Age 61

2 Distribution of patients based on

Gender 62


Locality 63


Religion 64


Marital Status 65

6 Distribution of patients based on socio

economic status 66

7 Distribution of patients based on diet 68


Appetite 70


Night sleep 71

10 Distribution of patients based on Day

sleep 72


Bowel/ consistency 73

12 Distribution of patients based on Type

of employment 74


Nature of cycles 79


Quantity 80

xiv

15 Distribution of subjects according to

the nourishment 81


the nadi 83


the Sparsha 84


the Akruti 85


the Prakruti 86


the Pramana 87


the satva 90


the Abhyavarana shakti 91


the Jarana shakti 92


the Vyayama shakti 93


the Aharaja nidana 94


the Viharaja nidana 96


the Manasika nidana 97


the Vataja Pandu lakshana 98


the Pittaja Pandu lakshana 99

xv


the Kaphaja Pandu lakshana 100

32 Distribution based on the Chromasia

of RBC’s 102

33 Distribution based on the Size of

RBC’s 104

34 Distribution based on the Shape of

RBC’s 106

35 Distribution of subjects based on the

presentation of Size & Color 108

LIST OF FIGURES

1. Figure showing Erythropoiesis

166

2. Figure showing RBC structure 166

3. Steps in the preparation of PBS 167

4. smear having Head, body and tail 167

5. Microcytic hypochromic picture of

RBC

167

6. Anisocytic hypochromic picture of

RBC

168

7. Target cells 168

8. Burr cells 168

Dr Shivani Kaundal 2018

xvii

“A STUDY ON THE DIAGNOSTIC VALUE OF PERIPHERAL

BLOOD SMEAR IN DIFFERENT TYPES OF DOSHAJA PANDU ROGA”

ABSTRACT

Loss in the normal color or discoloration of the body is called as Panduta. Along with

loss of normal color or discoloration of the body, loss or abnormalities are seen in the

texture and luster of body. Pandu roga has been regarded as Agnimandhya krita rasa

dushti janya pitta pradhana vyadhi1 which is characterized by Pandu vaivarnayata i.e.

ketaki dhuli samana varna2. The Pandu roga is included under the heading of

"Varnopalakshita Roga" i.e., Varna pradhanya vyadhi3. Pitta is responsible for the

normal color of the body but when it gets vitiated, there will be loss of complexion or

Panduta occurs. Pandu roga is referred as Vilohita, Harima, and Halima in Vedas and

Sushruta named it as Panaki, Lagharaka and Kumbhawayo.

Lakshanas have given a lot of importance in deciding or diagnosing a disease.

Samnaya lakshanas or general signs and symptoms which are present in the patient and

Vishishta lakshanas or specific signs and symptoms will depict the particular Dosha

involvement in the disease.

As in olden days there were no such modern technologies our Acharyas used their

keen observation in deciding the disease on the basis of Lakshanas. As with the

advancement of modern techniques like blood peripheral smear we are able to see the

changes in morphological structures of cells. Though numerous studies have been done

on Pandu roga but no work has been done to find out the morphological

changes/variations in cells in different types of Pandu roga. This study is aimed to find


xviii

out the relevance of morphological changes in the blood peripheral smear and to observe

scientific basis in various types of Pandu roga.

OBJECTIVES OF THE STUDY

1) To find out the relevance of peripheral blood smear in diagnosing different types of

Pandu roga.

2) To relate morphological changes in the RBC to the variants of Pandu roga.

METHODOLOGY

• After taking detailed history patient’s consent was taken and later they were subjected to

blood peripheral smear by finger prick technique. A drop of blood was taken and without

delay it was spread over the non-grease slide. Precautions such as length of the smear i.e.

3-4 cm, ideal thickness, and proper staining technique were adopted and slides were

thoroughly observed under the 100X oil immersion microscope.

• The distribution, size, shape and color of the red blood cell (RBC) and morphology of the

cells were carefully observed.

RESULTS

Amongst 50 subjects, 42 subjects were having Kaphaja Pandu,

Out of that 27 subject’s blood picture showed Microcytic Hypochromic RBC’s.

9 subject’s blood picture showed Anisocytic Hypochromic RBC’s.

6 subject’s blood picture showed Normocytic Hypochromic RBC’s.


xix

Amongst 50 subjects, 3 subjects were having Vata Pitta pandu,

2 subject’s blood picture showed Microcytic Hypochromic RBC’s.


Amongst 50 subjects, 3 subjects were having Vata Kapha pandu,

1 subject’s blood picture showed Anisocytic Normochromic RBC’s



Amongst 50 subjects, 1 subject was having Vata pandu, blood picture blood picture

presented with Anisocytic hypochromic.

Amongst 50 subjects, 1 subject was having Pittaja pandu, blood picture blood picture


CONCLUSION

• Among the population studied, Kaphaja Pandu is being commonly found than other

types of Pandu. As the main cause of this is sedentary lifestyle and irregular food habits.

• Among Kaphaja Pandu lakshanas most predominantly seen are Gourava, Tandra,

Aruchi, Alasya. In Pittaja Pandu lakshanas like Trishna, Daha and Murchha are

commonly seen. Similarly in Vataja Pandu lakshanas like Angamarda, Shiroshoola,

Parshvashoola are commonly seen.


xx

• Kaphaja pandu being more commonly seen among the studied subjects, their peripheral

blood smear showed Microcytic Hypochromic and also Anisocytic hypochromic RBC

picture. If we get the blood picture of Microcytic Hypochromic & Anisocytic

hypochromic it can be considered as Kaphaja Pandu.

• As there were less subjects of Vataja and Pittaja Pandu in the study, their findings in the

morphological changes in RBC in peripheral blood smear are insufficient in drawing out

a proper conclusion.

• Even though in classics Vata piita and Vata kapha Pandu roga is not mentioned

separately but in this study it was found in few subjects. So we can consider these types

on the basis of presentation of Lakshanas.

Dr. Shivani kaundal 2018

A study on the diagnostic value of peripheral blood smear in different types of Doshaja Pandu roga Page 1

INTRODUCTION

Loss in the normal color or discoloration of the body is called as Panduta. Along

with loss of normal color or discoloration of the body, loss or abnormalities are seen

in the texture and luster of body. Pandu roga has been regarded as Agnimandhya

krita rasa dushti janya pitta pradhana vyadhi1 which is characterized by Pandu

vaivarnayata i.e. ketaki dhuli samana varna2. The Pandu roga is included under the

heading of "Varnopalakshita Roga" i.e., Varna pradhanya vyadhi3. Pitta is

responsible for the normal color of the body but when it gets vitiated, there will be

loss of complexion or Panduta occurs. Pandu roga is referred as Vilohita, Harima,

and Halima in Vedas and Sushruta named it as Panaki, Lagharaka and

Kumbhawayo.

“Rogaaha sarvepi mande agnow”4 - as said by Vagbhata, Mandagni is also the major

factor in the pathogenesis of Pandu. The resultant effect of Mandagni is Rasadushti

and Rasa is the Pradhana dhatu involved in Pandu roga. So, Acharya Charaka as

well as Sushruta have included Pandu roga in Rasa pradoshaja vyadhi.,5,6

In Pandu roga there will be loss of normal color of body, as Ranjaka pitta with its

Ushma gives Raga to the Rakta poshaka sara bhaga of Rasa and produces Rakta and

is responsible for imparting color.

To see the morphological changes in Pandu roga, peripheral blood smear is the best.

Though numerous studies have been made on Pandu roga based on comparison with

the types of anemia, this was an attempt made to diagnose Pandu roga based on the

Samanya and Vishishta lakshanas mentioned in the classics, and to find out the

relevance of morphological variations in the RBC’s by studying the peripheral blood

smear.

Dr. Shivani kaundal 2018

A STUDY ON THE DIAGNOSTIC VALUE OF PERIPHERAL BLOOD SMEAR IN

DIFFERENT TYPES OF DOSHAJA PANDU ROGA Page 2

OBJECTIVES OF THE STUDY

1) To find out the relevance of peripheral blood smear in diagnosing different types of Pandu

roga.

2) To relate morphological changes in the RBC to the variants of Pandu roga.

Dr. Shivani Kaundal 2018



REVIEW OF LITERATURE

HISTORIC REVIEW

On the scale of time next to Vedas are the Puranas, Upanishads, Samhita, Sangraha,

Nighantus. Pandu Roga is mentioned in different texts/literature. It may be observed that the

Brihatrayis, were the earliest in medical literature. History of Ayurveda can be divided into:

1. Vedic period

2. Purana period

3. Samhita / Sangraha period

4. Modern period

VEDIC PERIOD

The earliest literature is “Vedas” and Ayurveda is closely acquainted with it. In Vedas there

are many references about Panduroga.

In Atharvaveda7 there are references like Vilohita, Harima, Halima which can be taken as

synonyms of Pandu roga. The significance of sunrays is also stressed for changing the color

of Pandu roga.

As per Mahabharata8 it states that the king of Hastinapur has suffered from

Panduroga whose name was Pandu Raja acquired the disease as a curse from a saint.

This explains the Karma siddhanta of Panduroga. King Pandu acquired sterility due

to Panduroga as a complication and he even died of the disease.

In Rigveda this disease has been mentioned under the name of Harima. And

“Suryanamaskara” is mentioned as its treatment.




Samhita and sangraha kala: It can be consider as golden period of Ayurveda, since

most of the classics like Charaka samhita, Sushruta samhita, Bhela samhita, Harita

samhita, kashyapa samhita were popular in this period. These Samhitas are the basis

of Ayurveda and are considered as Apta’s, and are practiced throughout the world.

Panduroga has been described in detail along with treatment in all the classics as

stated below:

NAME OF BOOK STHANA CHAPTER

1. CHARAKA SAMHITA Chiktsa 16th

2. SUSHRUTA SAMHITA Uttaratantra 44th

3. ASHTANGA SANGRAHA Nidana 13th

4. ASHTANGA SANGRAHA Chikitsa 18th

5. ASHTANGA HRUDYA Nidana 13th

6. ASHTANGA HRUDYA Chiktsa 16th

7. SHADANGADHARA SAMHITA Poorva khanda 7th

8. MADHAVA NIDANA 8th

9. BHAVA PRAKASHA Madhyamakhanda 8th

Even the works of Chakradatta, Vangasena, Yogaratnakara, also gives a detailed description

about Panduroga.




DISEASE REVIEW

VYUTPATTI

The word “pandu” is originated from the root “padi nashne” with pratyaya “Ku” and

elaborating through “Ni”9

The word “Pandu” is formed from the dhatu “Padi Gatou”. Padi means “gati”10

i.e. parinamana or transformation.

The word Padi Gatau (transformation) signifies the formation of Rasa, Rakta and other

Dhatus. If the transformation process is hampered or having any variation then it leads to

Pandu.

NIRUKTI

In Ayurveda, diseases are named after considering certain criteria. In some aspects they are

named after the predominant Dosha and Dushya eg, Rakta-Pitta, Vata-Rakta, on the basis of

similes, eg: Shlipada, Kroshtukasheersha, anatomical structures e.g: Hridroga, Shiroroga;

discoloration of the body e.g. Pandu, and based on pain as in Hrutshoola and

Parinamashoola and so on.

Pandu roga is a disease based on the presentation of its varna. .

Pandu Varna is the combination of Shweta and Peeta.11

Pandu Varna is a combination of Shweta and Peeta Varna in equal proportions,

similar to pollen grains of Ketaki.12

Pandu Varna is the combination of Shukla and Peeta (Raja Nighantu).




By observing the above references, it may be considered that Pandu Varna is the

combination of Shweta and Peeta Varna. Pandu is a Varnoplakshita Roga 13 i.e. color

indicating name, hence, its meaning is : to destroy natural color. The physiological natural

color of mucous membrane is pink. Loss or destruction of this pink color leads to whiteness,

palor , therefore Pandu means whiteness, palor.

PARIBHASHA

Charaka classified Rogas according to Ruja, Varna, Samuthana, Samsthana

and Sthana. In this classification the disease Pandu falls in the group of Varna. In

Pandu roga there is some significant change in the normal color of the body.

There are many definitions in Ayurvedic literature. A/c to Vijaya rakshit commentator

on Madhava nidana :

“Pandutwena upalakshito rogaha pandu rogaha” 14

which defines that a disease which is understood by its pandu varnatvam is a pandu roga.

“Panduna vakshayamana haritadivarnebhya pradhanena varnena upalakshito

rogaha pandu rogaha.” 15

a condition characterized by change in normal color (complexion) of the body that is

dominated by Pandu varna.

“Sarveshu cheteshivaha pandubhavo yatoadhikoatah khalu pandurogaha” 16

it stated that prevalence of Pandu vaivarnayta among the patients is more, hence it is

called as Pandu roga.




“Panduharidraharitan Pandutwam teshu chaditam yatoataha pandurityuktasa

rogaha”17

Although several types of complexions like haridra, harita etc. are described. Among

all of these the dominant one is Panduta. Hence, this is called as Pandu Roga.

“Panduhu swetavarna ketakidhuli sannibha peetabhagarda

varnabhedcha” (Shabdasthoma)

Pandu has been compared with ketaki dhooli or ketaki pushpa color i.e. can be

considered as a combination of white and yellow colors.

“Swetha peeta samayukta panduvarna prakirtitaha”

(Amarakosa)

The combination of white and yellow colors in equal proportion are called

Pandu roga.

It can be concluded on the above basis that Pandu roga has been regarded as disease

associated with discoloration of the skin or mucous membrane of the patient.

PARYAYA

“Sa kamala panaki pandu roga kumbhwayo lagharakoalasakhya vibhashyate

lakshanamasya kritsanm nibodha vakshyamyanupoorvashasthoth”

Sushruta used the terms Kamala, Panaki, Panduroga, Kumbahwayo, Lagharaka, Alasa 18 as

synonyms of the disease. Though Kamala etc. are considered as synonyms of Pandu, even

then, Pandu and Kamala are separately explained in terms of Nidana, Lakshana and Chikitsa.

Dalhana clarifies that Acharya Sushruta has considered it as a synonym only on the basis of




Kamala being an Avastha Vishesha of Pandu. Charaka also includes Haridra, Harita and all

other skin discolorations under Pandu. The synonyms of Pandu roga available from Vedic

literature are Vilohita, Harima, Halima.19

BHEDA

In vedic literature there is no evidence of any classification regarding Pandu roga.

Only synonyms such as Harima, Halima, Vilohita are found in the literature.

The detail description of Pandu roga and is classification starts from Ayurvedic

samhitas only. The classification of Pandu roga most of the Acharyas accepted 5 types.

Those are (1) Vataja (2) Pittaja (3) Kaphaja (4) Sannipataja (5) Mrudbhakshanaja.

Acharya Sushruta excluded the Mridbhakshanaja Pandu, but he included under Vatadi

doshaja Pandu’s according to the Rasa pradhanata of Mrit20

In Harita Samhita one of the 5 types of pandu roga, “Rukshana”21 is mentioned. The

term Rukshana may be used, because Mridbhakshanaja Pandu mainly causes the Rukshtwa

of the body.

Astanga sangraha and many other texts followed Sushruta as they mentioned four

types. Some commentators classified Pandu into eight types as follows:

1. Vataja 5. Pittaja

2. Kaphaja 6. Sannipataja

3. Mritbhakshanajanya 7. Shakhasrita kamala

4. Koshtashrita kamala 8. Haleemaka




A Classification states that Mritbhaskhanajanya Pandu22 falls under Sannipataja Pandu

because of the following reasons:

Intake of Kashaya rasa predominant Mritika leads to Vataja Pandu.

Intake of kshara rasa predominant Mritika leads to Pittaja

Pandu.

Intake of Madhura rasa predominant Mritika leads to Kaphaja,

Pandu.

Sushruta might have included Mritbhaskhanajanya Pandu under Sannipataja Pandu due to

the above said reason.

Table no: 1

Classification of Pandu according to different authors

S.No Samhita Types Vata Pitta Kapha Tridosha Mritbhakshan

a

1. Charaka 5 + + + + +

2. Sushruta 4 + + + + -

3. Ashtanga

sangraha

5 + + + + +

4. Ashtanga

Hrudaya

5 + + + + +

5. Madhav Nidana 5 + + + + +

6 Shadangadhara 5 + + + + +

7 Bhavaprakash 5 + + + + +

8 Harita 5 + + + + Rukshana




9 Yogaratnakara 5 + + + + +

NIDANA 23,24

“Nimitta hetwayatana pratyayothana karnahinnilaka mahuparyaythi”

“Seti kartavyatako rogotpadaka heturnidanam”

Ahitha ahara vihara leads to the vyadhi by vitiating Doshas and Dhatus. The following are

the nidanas of pandu roga.

Nidanas25 can be divided into following three types:

1. Ahara nidana

2. Vihara nidana

3. Manasika nidana

1) AHARAJA & VIHARAJA NIDANA :

Improper diet and routine practices are the prime factors responsible for the disease

manifestation particularly when taken in excess. Such etiological factors are:

1) Rasa – Amla, lavana, kshara.

2) Guna – Ruksha, ushna, tikshna.

3) Veerya – Ushna.




4) Dravya – Vidagdha anna, nishpava, pinnyaka, matsya, amisha, pista, paya, tila taila,

masha atisevana, Madya.

TABLE 2:

Nidanas of Pandu Roga

Sl. no

NIDANA C.S. Su. S. A.H. M.N.

AAHARJA NIDANA

RASA VISHESHA

1 Kshara ati sevana + - - -

2 Amla ati sevana + + + +

3 Lavana rasa ati

sevana

+ + + +

4 Kashaya rasa ati

sevana

GUNA VISHESHA

5 Ati Ushna bhojana + - - -

6 Ati Tikshana ahara

sevana

- + + +

7 Ati Ruksha ahara

sevana

AAHARA KRAMA

8 Viruddha bhojana + - - -




VIHARAJA NIDANA

The viharaja nidana plays a vital role in the manifestation of the vyadhi. These are:

1) Diwaswapna: Diwaswapna vitiates Tridosha and depresses the function of Jathraagni

and Dhaatwagni.

2) Madya: Madya does Pitta vitiation.

3) Ati vyayama: leads to Pitta prakopa.

4) Ati maithuna: causes Tridosha prakopa

5) Panchakarma vaishamya & Vegadharana: does vitiation especially to Vata.

9 Vidhagdha anna + - - -

DRAVYA VISHESHA

10 Nishpava sevana + - - -

11 Tilataila sevana + + - -

12 Pinyaka ati sevana + - - -

13 Masha ati sevana + + - -

14 Madya sevana - + - +

15 Mrut bhakshana + + - +




Table no 3:

Showing the viharaja nidana of pandu roga according to various authors

MANASIKA NIDANA

Only Charaka has mentioned Manasika Nidana which can lead to Pandu. These are as

follows:

1) Kama, Shoka, and Bhaya vitiates Vata.

2) Krodha vitiates Pitta.

3) Chinta and Manasantapa vitiates Vata & Kapha.

S.No Nidana C.S Su.S A.H M.N

1 Ati Maithuna + - - -

2 Vega Vidharana + - - -

3 Panchakarma

vaishamya

+ - - -

4 Rutu vaishamya + - - -

5 Divaswapna + + - +

6 Ati Vyayama + + - +

7 Nidra nasha - - - -




Table no 4:

Manasika nidana of pandu roga according to various authors.

Table No:5 Nidana with effect on Dosha-Dushya

S.no Nidana C.S Su.S As.H M.N

1 Bhaya + - - -

2 Chinta + - - -

3 Krodha + - - -

4 Manasantapa + - - -

5 Shoka + - - -

S.No

Dravya

Guna

Effect on dosa - dushya

1. Nishpava Ruksha guna,

Amla vipaka,

Ushna veerya

Glanikaraka, Sukranashaka, Vidahi,

Pitta vata vardaka

2. Masha Madhura rasa,

Guru vipaka

Kapha prakopaka, Kledakaraka

Klaibyakaraka

3. Pinyaka Ruksha guna,

Guru paki,

Ushna veerya

Vidahi , Vata pitta vardaka, Sukra

nashaka, Raktapitta prakopaka




4. Tila taila Madhura kashaya

rasa, Ushna veerya

Raktha pitta prakopaka

5. Tila pishta Ushna & Guru Pitta karaka,

Rakta prakopaka

6. Paya

sevana

Madhura rasa,

sheeta veerya,Guru

snigdha

Kapha vardaka ,

Kleda karaka

7. Matsya

(Samudra)

Ushna veerya,

Kapha-pittakara

Kapha-pitta vardaka,

Rakta prakopaka

8. Amisha

(mamsa)

Ruksha & sheeta Vata- pitta prakopaka,

Rasa rakta dusti karaka

9. Ikshu

sevana

Madhura rasa,

Sheeta veerya

Snigdha, sara guna

Kapha prakopaka,

Ama karaka,

Abishyandaka

10. Ruksha, ati

sevana

Katu, ushna Vata prakopaka,

Rakta dusti karaka,

Kapha soshaka

11. Maruta

sevana

Kashaya- vata

Katu- pitta

Madhura - kapha

Tridosha prakopaka

Sroto avarodhaka,

Krimi janaka

12. Madya Amala rasa

Katu vipaka

Ushna, vidahi

Pitta prakopaka - Ojo nashaka

Kapha shoshaka- Rakta dusti

karaka




POORVA ROOPA

“Sthanasamsraymaha kruddha bhavi vyadhi Prabhodhakam,

Doshaha kurvanti yallingam poorvaroopam, Taduchyute.”

Based on Dosha - Dushya Sammurchanna the Sthana Samshraya takes place in the

body during fourth phase of kriyakala. As a result Doshas dushti will manifest which

indicates the actual disease manifestation. In Pandu Roga, Poorva Roopa and Roopa are

intermixed with each other, because most of the symptoms of Poorva Roopa avastha can be

appeared in Roopavastha too. Acharyas have mentioned Poorvaroopa in Pandu roga which

are as follows:

According to Charaka26:

1. Hridaya spandanadhikya

2. Roukshyam

3. Swedabhava

4. Shrama

According to Sushruta27:

1. Twaksphotana

2. Steevana

3. Gatrasada

4. Mrid Bhakshana iccha

5. Prekshana akshi koota shotha

6. Avipaka




7. Vitpeetata

8. Mootra peetata

According to Astanga Hridya28

1. Hridaya spandana

2. Ruksha twacha

3. Aruchi

4. Peeta mutrata

5. Sweda abhava

6. Alpa vanhita

1) Hridaya Spandanadhikya: This is due to the Prakopa of Pitta pradhana tridosha. In the

Hridaya, the Chala guna of Vyana vayu along with Sara guna of Sadhaka pitta causes Rasa

dhatu kshaya and reduced Preenana to the Dhatus. It causes increased functioning of

Hridaya, which is its mulasthana, producing Spandanadhikya.

2) Twak Roukshya or Twak Sphutana: Twak Roukshya or Twak Sphutana are produced

due to:

Increased Vyana Vata

Raktadhatu kshaya

Sara hani

3) Swedabhavata: Swedabhava can be caused by Srotorodha due to Kapha.




4) Shrama: Shrama can be produced by:

Vyanavayu vriddhi

Rasa, Mamsa, Meda, Asthi, Shukra and Ojokshaya

5) Steevana and Hrillasa: Due to Malaroopi kapha vriddhi produced by Rasa

dhatwagnimandya, Shteevana and Hrillasa are seen in Pandu.

6) Gatrasada: It is caused by Vyana vayu prakopa and Ojokshaya.

7) Mrit-bhakshana Iccha: It is due to the vitiation of Sadhaka pitta, which disturbs Dhriti

and Medha which leads to the disturbed mental state and provoke the patients to do such

activities.

8) Prekshana Koota shotha: when there is increased Malaroopi kapha which lead to

Srotorodha, thus cause Prekshana koota shotha.

9) Aruchi, Avipaki: Increased Pitta (drava rupi) when produces Agnimandya produces

Aruchi, avipaka.

10) Peetata of Vit and Mootra: Dravyataha vriddhi of pitta due to Nidana and the vicious

cycle of Rakta-agnimandya, thus increases Ranjaka pitta and causes increased coloration

of Vit and Mootra.




ROOPA

“Tadeva vyaktata yatam roopam iti abhidheeyate”29.

The Poorva roopa which has attained vyaktavastha known as roopa. This is the stage of a

disease where the signs and symptoms of the disease are totally manifested is fifth kriya

kaala termed as ‘vyaktibhava’. When the disease starts to take its stage forth kriyakala

namely in the Stanasamshrayaavastha or Poorvaroopavasta and when it is not treated the

doshas get accumulated and manifestation into the diseased state – “ROOPA”.

Hence, Rasa being the Dhatu where Doshas undergoes Sthanasamshraya, almost all of

Rasavaha sroto dushti lakshanas can be observed in Pandu Roga. They are Aruchi,

Ashraddha, Agnimandya, Hrillasa, Arasagnatha, Gourava, Tandra, Angamarda, Pandu,

Jwara, Klaibya, Sada, Krishnagata and Palitya.

SAMANYA LAKSHANA30,31,32,33

1. Panduta: It is the Pratyatma lakshana of Pandu. Pandu roga is named on the basis

of discoloration of body parts. This is due to Rasa pradosha.

2. Dourbalya: Means reduction in the normal Bala, Normal Bala is measured by

Vyayama shakti. In Pandu it is reduced due to Dhatukshaya.

3. Karshya: Reduction of various Dhatus in body leads to affliction of Samhanana

leading to emaciation of Spik, Udara, Greeva.

4. Karna Kshweda: Due to weakness in the sense organs, increased Vata produces this

symptom and is one of the Vataja nanatmaja vyadhi.

5. Gatra peeda: Different types of pain in the different parts of the body caused by

Vata vriddhi due to Dhatu kshaya.




6. Shoonakshi koota shotha and steevana: these lakshanas can be observed from

Poorvaroopa avastha. Kapha vriddhi producing Srotorodha leads to Shoonakshi

koota shotha.

7. Sheerna loma: Asthi dhatu kshaya.

8. Hridrava: Means increased sensation of Hrit Gati. Involvement of Sadhaka pitta,

Vyana vayu, Raktavaha srotodushti causes Hridrava.

9. Shwasa: Due to Dhatu kshaya and Dourbalya shwasa is produced. Even debility in

the Hridaya can cause Shwasa. Prakopa of Pranavayu can also cause Shwasa.

There, it refers to Arohana Ayasa (exertional dyspnoea). But in Upadrava stage, it is

severe state of Kshudra Shwasa.

10. Bhrama: Vata-pitta-rajogunadhikya leading to various Dhatu kshaya like Majja and

Rakta will lead to Bhrama.

11. Anna dwesha: Charaka mentioned both Annadwesha and Aruchi in Samanya

lakshana. Sushruta has mentioned this in Upadrava stage and is caused due to

Kapha vriddhi and Agnimandya.

12. Gourava: Heaviness of body indicates Kapha and Ama vriddhi and is one of

Kaphaja nanatmaja vikara.

13. Jwara: Indicates Pitta prakopa.

14. Harita Varna: Indicates Pitta vriddhi.

15. Hata prabha: Pitta prakopa, Oja kshaya cause Prabha hani.

Table No. 6.

Showing Samanya Lakshana’s

Sl.NO LAKSHANA C.S Su.S As.H As.S K.S

1 Twak Vaivarnayata + + - - -




2 Anna Dwesha + - + + -

3 Alpa Vak + - + + -

4 Hatanala + - + + +

5 Nidralu + - - - -

6 Shuna Akshi Koota + - + + +

7 Anga Sada/ gatra peeda + - - - -

8 Sthivana + - + + -

9 Kopana + - + + -

10 Shishira Dweshi + - + + -

11 Sheerna Loma + - + + -

12 Jwara + - + + -

13 Shwasa + - + + -

14 Karna Kshwedi + - + + -

15 Bhrama + - + + -

16 Shrama + - + + -

17 Hataprabha + - - - -

18 Dourbalya + - + + -

19 Pindikodwestana + - - - -

20 Kati,Uru, Pada Ruk + - - - -

21 Sadana + - + + -

22 Arohana Ayasa + - - - -




TABLE No 7:

Samanya Lakshana’s with their amshamsha kalpana 34:

Sl.

No

Lakshana Dosha Gunathah Amsamsa

kalpana

1. Karna kshweda Vyana Vata Chala guna,

Shabdtah

2. Hrudaya

spandana

Vyana vata

Sadaka pitta

Chala gunataha

Sara gunataha

-

3. Dourbalya Vata vridhi,

Ojo Kshaya

Karmatah

4. Twak rukshata Vyana vata Ruksha

gunataha

-

5. Sweda abhava Kapha Medo-mala

vridhi

Srotoavarodh

a

6. Shrama Vata Vyana

vata

- Rasa kshaya

7. Bhrama Vata vriddhi,

pittavriddhi

kapha kshaya

chala guna,

sara guna,

8. Twak spotana Vata Ruksha

gunataha

-




9. Steevena Kapha - Rasa/ Ama

10. Gatra shoola Vata Vridhi Sheeta

gunatah-

Ojo kshaya

11. Mrid bhakshana Tridosha - Prabhava

12. Prekshana akshi

koota shotha

Kapha vridhi - Srotoavrodha

13. Shwasa Vata kshaya, Chala guna,

Sukshma guna

-

14. Vin-mootra

peetata

Pitta Roopata vridhi -

15. Avipaka Pitta Drava-roopa

vridhi

-

16. Aruchi Kapha vridhi Guru guna,

Drava-roopa

vridhi

-

17. Hataprabha Pitta Kshaya Rooptah -

18. Pippasa Vata-pitta

vridhi

Udaka kshaya -

19. Shishira Dweshi Pitta vridhi,

Vata vridhi

Drava-roopa

vridhi

-




VISHISHTA LAKSHANA

They are the specific features observed independently in every disease because of the

involvement of dosha, dushya and strotas. Vishishta lakshanas help us in diagnosing the type

of disease in particular and also in planning the treatment accordingly.

Vataja Pandu35,36,37,38:

If there is Vata vriddhi, it produces various Vataja lakshana like Krishnata, Panduta in body

parts and various types of Shoola.

Table No.8:

VATAJA PANDU LAKSHANA

Sl. No. Lakshana C.S. S. S. A.H. A.S. M.N. B.P.

1 Krishna pandutwa + - - - - -

2 Ruksha angata + - + + + +

3 Arunangata + - - - + +

4 Angamarda + - - - - -

5 Raja + - + + - -

6 Toda + - + + + +

7 Kampa + - + + + +

8 Parshwa shoola + - + + - -

9 Shirashoola + - + + - -

10 Varcha shosha + - + + - -

11 Asya vairasya + - + + - -

20. Nidralu Kapha vridhi Guru Guna -




12 Shopha + - + + - -

13 Anaha + - + + + +

14 Bala kshaya + - - - - -

15 Krushna akshi - + + + - -

16 Krishna Sira - + - - - -

17 Krishna Varnatwa - + - - - -

18 Krishna mala - + + + - -

19 Krishna mootra - + + + - -

20 Krishna nakha - + + + - -

21 Krishna anana - + - - - -

22 Aruna sira - - + + - -

23 Aruna nakha - - + + - -

24 Aruna mala - - + + - -

25 Aruna mootra - - + + - -

26 Aruna akshi - - + + - -

27 Bhrama - - - - - -

28 Vata upadrava - + - - - -

29 Krishna sira - - + + - -

30 Aruna sira - - + + - -

31 Twak krishnabhata - - - - + +

32 Mootra krishnabhata - - - - + +

33 Nayana krishnabhata - - - - + +

34 Twak arunabhata - - - - + +

35 Mootra arunabhata - - - - + +




36 Nayana arunabhata - - - - + +

37 Rakta netra - - - - - -

38 Aruna twak - - - - - -

Pittaja Pandu 39,40,41,42:

Pitta vriddhi produces various Pittaja lakshana like Peetabhata, Haritabhata, Jwara.

Table No. : 9

Showing Pittaja Pandu Lakshana

Sl. no.

Lakshana

C.S

S. S

A.H

A.S

.

M.N

.

1 Peetabha + - - - -

2 Haritabha + - + - -

3 Jwara + - + + +

4 Daha + - + + +

5 Trishna + - + + +

6 Moorcha , pipassa + - - - -

7 Peeta mootra + + - - +

8 Peeta shakrut + + - - +

9 Swedana + - - - -

10 Sheeta kamita + - + + -

11 Na annam bhinandathi + - - - -

12 Katukasya + + + - -




13 Anupashaya - - - - -

14 Ushna + - - - -

15 Amla + - - - -

16 Amla udgara + - - - -

17 Vidahata + - - - -

18 Vidagdhata + - - - -

19 Dourgandhya + - + + -

20 Bhinna varcha + - + + +

21 Dourbalya + - - - -

22 Tama + - + + -

23 Peeta akshi - + - - +

24 Peeta Sira - + - - -

25 Peeta nakha - + - - -

26 Peeta anana - + - - -

27 Moorcha - - + - -

28 Amlata - - + - -

29 Atipeetabha - - - - +




Kaphaja Pandu43,44,45,46:

Kapha vriddhi produces various Kaphaja lakshana like Shuklavarnata, Gourava and

Shwayathu.

TABLE NO. 10:

Showing kaphaja Pandu Lakshana

SL no. LAKSHANA C.S. S. S. A.H. M.N

.

1 Gourava + - - -

2 Tandra + - + +

3 Chardi + - + -

4 Shewatavabhasata + - - -

5 Praseka + - - +

6 Lomaharsha + - + -

7 Sada + - - -

8 Moorcha + - - -

9 Bhrama + - - -

10 Klama + - - -

11 Shwasa + - - -

12 Kasa + - + -

13 Alasya + - - +

14 Aruchi + - - -

15 Vatagraha + - - -

16 Swasa graham + - - -

17 Shukla motra + - - +




18 Shukla akshi + - - +

19 Shukla varcha + - - -

20 Katu kamatwam + - - -

21 Ruksha kamata + - - -

22 Ushna kamata + - - -

23 Shwayatu + - - +

24 Madhura asya + - - -

25 Shukla sira - + + -

26 Shukla nakha - + - -

27 Shukla anana - + - +

28 Lavana asyata - - + -

29 Swara kshaya - - + -

30 Ati gourava - - - +

31 Shukla twacha - - - +

Tridoshaja Pandu47,48,49,50:

Tridosha prakopa causes presentation of all the Tridoshaja lakshanas.

TABLE NO. 11

Showing Tridoshaja Pandu Lakshana

Sl.No. Lakshana G.N. H.S.

1 Jwara + +

2 Arochaka + -

3 Hrillasa + +




4 Vamana + +

5 Trishna + +

6 Bhrama + -

7 Tandra - +

8 Alasya - +

9 Shotha - +

10 Kasa - +

11 Shosha - +

12 Vitbandha - +

13 Parushata - +

14 Klama - +

15 Moha - +

SAMPRAPTI51,52,53,54

The genesis (evolution, process of manifestation) of the disease by the Dushti of Doshas

which are constantly circulating is called as Samprapti. Every factor connected with the

process of disease at various stages is considered in detail in samprapti. The disease process

starts with Nidana and then passes through Sanchaya, prakopa, prasara, Sthana samsraya

and finally manifestation of Vyaktavastha, i.e. manifestation of Pandu. This complete disease

process is called as samprapti.

In other words Samprapti gives detail information about the pathogenesis of the disease. It

gives a clear idea of the disease process helping management of the condition. Both Charaka

and Sushruta considers Pandu to be a Rasa vaha sroto vikara 5,6 and clearly projects Pitta




dosha as the major factor behind the whole pathogenesis in Pandu. Due to the involvement of

rasa, rakta and Ojas the main presenting symptom is Panduta, Indriya-Bala- Varnahani and

the Nidanas for Pandu is Pittaja nidanas.

Samprapti of Pandu can be explained and understood based on Shatkriyakala- Sanchaya,

Prakopa, Prasara, Sthanasamsraya, Vyaktha and Bheda.

A/ c to Madhavanidana, samprapti can be understood as below:

"Yatha dushtena doshena yatha cha anu visarpatu

Nivrutti Ramaya - Syasan samprapti jati ragati" 55

Samprapti can also be called dosha dooshya sammurchana avastha of a particular vyadhi. In

Pandu Roga generally three Doshas are involved and in particularly Pittadosha. The Pitta

prakopakara Ahara and Vihara are the causative factors of Pandu. Because of these nidanas

pitta vridhi takes place. Physiologically, the formation of Acchapitta, occurs in Grahani

during ahara parinama. But due to katu, amla, lavana, ushna ahara and other causes

mentioned earlier, vitiation of Pitta takes place. Since Pachaka pitta is situated in Grahani,

the vitiated Pitta affects the Agni. The Drawatwa in this vidagdha pitta reduces its

teekshanatwa. This Agni cannot digest the ahara consumed, there by leading to vidagdha

bhava.

Generally, after pachana, the food consumed is divided into Sarabhaga and Kittabha by

Samana vayu and the saarabhaga is taken to Hridaya. But due to vidagdha pitta, pachana

does not occur properly leading to dooshita annarasa. The Annarasa is taken by samanavayu

to Hridaya and transforms it into Rasadhatu. The viharas like Vyayama, Vyavaya etc cause

vitiation of vyanavayu. The vitiated Vyana vayu along with pitta - dooshita rasadhatu

circulates throughout the body through Dasa Dhamanis which emerge from Hridaya. The

pitta dooshita rasa dhatu flows into the next dhatu for its nourishment malformed rasa dhatu




due to Pitta vidagdata, destructs the Raktadhatu poshakamsas and attains pandu roga, which

will not be in a position to nourish Dhatus. Finally rasadhatu lodges in the space between

twak and mamsa. Then by vitiating the kapha, vata, rakta, twak, and mamsa, it produces

pandu, haritha and haridra varnas, or various other discoloration of the skin. Of these colors,

Pandu is seen predominantly. The formation of all the other dhatus is also impaired. As a

results of this, the formation of next dhatu i.e. Raktadhatu is affected. Even the essence which

comes out from each Dhatu also reduces in it’s quantity. As the essence of all Dhatus is Ojus,

its kshaya lakshanas can also be observed on progression of the diseases.

Schematic representation of Samanya Samprapti of Pandu Roga.

NIDANA SEVANA

PITTA PRADHANA TRIDOSHA PRAKOPA

HRIDAYA KHA VAIGUNYA

RASA DUSHTI

PITTA + DUSHITA RASA

CIRCULATES THROUGH DASHADHAMANI VYANAVAYU

ASHRAY IN TWAK & MAMSA

VITIATES RAKTA, KAPHA, VATA, TWAK, MAMSA

PRODUCES HARIDRA, HARITA AND PANDU VARNA.

PANDU ROGA




Samprapti ghatakas:

The components involved in Samprapti or pathogenesis of a Vyadhi are called as Samprapti

ghatakas. Understanding these components and their Samprapti ghatakas status helps

Samprapti vighatana and paves the way for Chikitsa .

1) Dosha- Pitta pradhana tridosha

2) Dooshya- Rasa, Rakta

3) Agni- Jatharagni dusti, Rasa agni, Rakta agni (mandagni)

4) Srotas- Rasa vaha srotas, Raktavaha srotas, Annavaha srotas

5) Udbhava sthana – Amashaya

6) Vyakta sthana – Sarva shareera

7) Sanchara sthana- Dashadhamanis and Sarvashareera

8) Ashraya- Twak and Mamsa

9) Roga Marga- Bahya




1. DOSHAS:

A. VATA:

a. Vyanavata56

Sthana: Hridaya – Seat of Vyanavata (Vagbhata)

Both Charaka and Sushruta did not mention about the place of Vyanavata.

Gunas: In general, it possesses all the gunas of vayu. These are Ruksha, Laghu, Sheeta,

khara, Sookshma, and Chala.

Karmas:

1. The Movement is entirely dependent on Vyana Vayu.

2. Rasa Raktadi samvahana

3. Sweda & Asrik sravana.

4. Sareera Chestha: Prasarana, akunchana, vinnamana, unnamana and

tiryaggamana

5. Jrimba pravartana

6. Anna dwesha

7. Sroto vishodhana

8. Dhatu tarpana

b) Samana Vata57: The Vayu that gives strength to Pachaka pitta is called Samana

Vayu.

Sthana: Samana vata resides near pachaka pitta. It courses between Amashaya and

Pakwashaya. It is also been said that it also occurs in Sweda, Rakta, and Ambu vaha srotas.

Gunas: In general, it possesses all the gunas of vayu.




Karma: The important function of Samana Vayu is to strengthen Jataragni. Thus it

helps in the digestion of food. After digestion, it divides Ahara into Saara and Kitta bhaga.

According to Vagbhata, samana vata does the Ahara graham (accepts food) into koshta,

Anna grahana, Saara-Kitta vibhajana and it pushes the Kitta into Pureesha vaha srotas.

B. Pitta:58

a) Pachaka Pitta: The Pachaka piita or Pachakagni is made up of Panchamahabhutas, but

owing to its Tejo guna and action like pachana etc. this does the Annapachana and regulates

digestive capacity, Dhatu parinama and provides nutrition for the body. It has also been said

that vitiation of Pachaka pitta leads to disease.

Sthana: Pachaka pitta is located in between Amashaya and Pakwashaya. The region

between Amashaya and Pakwashaya is termed as Grahani and it contains Pittadhara kala. In

other words, Pittadhara kala or Grahani is seat of Pachaka Pitta.

Gunas: Laghu, Visra, Sara, Drava, Sneha, Teekshna, Ushna, and Visada

In Pachaka pitta, the Tejo guna pradhanta is seen and because of it, the drava guna in

Pachaka pitta is less when compared to other types of Pitta.

Karma:

Pachaka pitta has numerous functions. The important functions among them are as follows:

i. It digests the four types of food and liquids we consume.

ii. It differentiates Saara bhaga and Kitta bhaga of the food after digesting it and

absorbs into the body.

iii. It is termed as ‘Jatara Agni’ many times, because it controls the action of other 12

types of Agni in the body.




iv. The other factors that are dependent on the action of Pachaka pitta are given below.

Ojas

Ayu.

Deha pushti

Bala

Utsaha.

It is also said that if Kayagni is healthy, then the person achieves longevity, else he

acquires diseases and if the Kayagni is totally diminished, the person dies.

b. Ranjaka Pitta59: The Pitta that imparts color to Rasa dhatu and transforms it into

Rakta dhatu is called Ranjaka pitta or Ranjakagni pitta.

“Amashayaashrayam Pittam ranjakam rasaranjanat”

Sthana: According to Sushruta – Yakrit and pleeha

According to Vagbhata – Amashaya

According to Sharangadhara - Hridaya

Gunas: Laghu, Visra, Sara, Drava, Sneha, Teekshna, Ushna, and Visada

Karma: Ranjaka pitta gives color to the Rasa Dhatu when it is circulated through Yakrit and

Pleeha and transforms it into Rakta Dhatu. This act is even controlled by Rakta Dhatwagni.

c. Bharajaka Pitta 60: The temperature of the body as well as the color of the skin

depends on Bhrajaka pitta.

“Twakstham bhrajakam bhrajana twachaha”




Sthana: Twak is the sthana of Bhrajaka pitta. Avabhasini, which is the first layer of Twak,

lodges Bhrajaka pitta according to Dalhana.

Gunas: Laghu, Visra, Sara, Drava, Sneha, Teekshna, Ushna, and Visada.

Karma:

I. The main action of Bhrajaka pitta is to maintain the normal body temperature.

II. In general, Bhrajaka pitta imparts different colors to the body depending upon the

Mahabhoota composition of the skin.

According to Charaka:

Jala & Akasa Mahabhoota predominance leads Gowra Varna.

Prithvi Mahabhoota predominance leads Krishna Varna.

Prithvi & Akasa Mahabhoota predominance leads Krishna Shyava Varna

C. Kapha:61

a) Kledaka kapha

Sthana: kledaka kapha resides in Urdhwa Amashaya.

Gunas: In general, it possesses all the gunas of Kapha such as Snigdha, Seetha, Guru,

Manda, Slakshna, Sandra, and Sthira.

Karma: 1. Anna sanghata 2. Kledana

The impairment of these functions is supposed to vitiate ahara which may result into

Pandu.




2. DHATUS:

The Dhatus which are involved in the pathogenesis of Pandu are Rasa, Rakta, Mamsa

and Meda.

a) Rasa Dhatu 62:

The involvement of Rasadhatu is not directly related in the Pathogenisis of Pandu roga

samprapti. Pandu is included under rasa prodoshaja vyadhi.

Location: Hridaya and Dashadhamanis. It circulates throughout the body along with Rakta

with the help of Vyanavata.

Pramana: 9 Anjalis

Rasa: Madhura

Varna: Swetha/Shukla

Formation: It is formed from Saarabhaga of ahararasa after it has been subjected to

jatarapaka and Rasa dhatwagnipaka. It circulates upwards like Agni, downwards like jala

and transversely like shabda.

Karma: 1. Tarpana

2. Jeevana & Preenana

3. Vardhana

4. Dharana

5. Yapana

6. Uttarottara dhatu poshana




b) Rakta Dhatu63The essence of Ahaara after being subjected to Paaka by Ranjaka pitta

attains red color and becomes rakta dhatu. Therefore the Ranjaka pitta 64 plays an essential

role in the formation of the Rakta dhatu.

The nidana of Raktadusti are similar to that of Panduroga . The characteristic features

of Pandu are quite opposite to the Shuddha rakta purusha lakshana. The Pandu roga is

mentioned under Rakta kshaya lakshanas.

Sthana: Yakrit, Pleeha, Hridaya, Rakta vahadhamanis and Sa-rakta medas. It

circulates in the entire body along with Rasadhatu.

Pancha bhoutika Sanghatana of rakta 65:

“Panchabouthikam twapare Jeevarakta maharacharyaha

Visratha Dravatha Ragada spandanam Laghuta tatha

Bhooamyadenaam gunahyethe dryshantey chatra shonity”

Qualities of Rakta dhatu Mahabhoota Pradhanyata

1. Visrata - Fleshy odour Prodhweebhuta

2. Dravta – Fluidity Jalabhuta

3. Raga – coloration Agnibhuta

4. Spandana – movement Vayubhuta

5. Laghuta – lightness Aakashabhuta

Rasa: Madhura, lavana rasas.

Varna of shuddha rakta dhatu66:




“Tapaniyendra Gopabham padmalaktaka sannibha

Gunjaphala savarnacha vishuddam vidhisonitam”

The pure blood resembles a bright “Indragopa” (firefly)

Looks like Padma (Lotus flower) and Latuka (Laksha)

Gunjaphala Sa-varnam – Bright red like gunja seed.

Pramanas: Eight Anjalis.

Gunas: Anushna, Seetha, Snigdha, Guru, Visra and Asamhata and Gunas of

Panchamahabhutas.

Karma: Jeevana, Dharana, Bala, Varna, Sukhakara, Ayushkara, Pushtikara,

Indriyaprasannatwa, mamsapushti and sparshagnanakara.

Shuddha Raktasaara Purusha Lakshanas67: A person whose karna, mukha, jihwa,

nasa, osthta, pani, paadatala nakha, lalata and mehana are having snigdha and rakta Varna

is regarded as Shudda Raktasaarapurusha.

3. OJAS68:The involvement of Ojas is specifically mentioned in Charaka Chikitsa 16th

Chapter. Ojas is the essence of all the sapta dhatus, from Rasa to Shukra and is responsible

for the strength of an indivisual. As the formation of all Dhatus is impaired in Pandu, the

formation of the essence of all Dhatus also impairs and ojokshaya lakshanas can be seen. In

classics Prakruta Kapha, Rasa, Rakta, Shukra, Sarva dhatu sara and Agni are also referred to

as Ojas 69.

Sthana: Hridayam, Sarva shareeram




Bheda: Para and Apara

Pramana: Para Ojus – Ashta bindu

Apara Ojus – Ardha anjali

Rasa: Madhura

Varna: Eshatpeeta varnam (or) Sarpi varnam.

Karma: Sthiropachita mamsaata , Swara-varna prasaada,

Vyadhikshamatwakaram.

4. SROTAS:

The Strotas that are affected in Pandu are Rasavaha and Raktavaha.

a) Rasavaha srotas70:

The Moolasthana of Rasa dhatu is Hrudya and dashadhamanis. Pandu is a Rasa pradoshaja

vikara. In Pandu due to Agnimandya, Rasa dhatu is first affected, the Prakupita pitta having

sthanasamshraya in Hridaya (mula sthana) spreads all over the body through

Dashadhamanis and causes different Rasa vaha srotodushti lakshanas 71

like-

Ashraddha

Aruchi

Asaya vairasya

Arasa sagnata

Hrillasa

Gourava




Tandra

Jwara

Angasada

Pandutwa

Thus, producing Rasa kshaya along with the kshaya of other Dhatus, as its Preenana

karma is affected.

b) Raktavaha srotas72

Yakritmoola and Pleeha are the Raktavaha strotomula. Rasaranjana takes places in Yakrit

and Pleeha. The improper formation of Rasa dhatu leads to improper formation of Rakta

dhatu. Along with it Pachaka pitta, Sadhaka and Ranjaka pitta are also affected. Thus

producing Rakta kshaya by vitiating Raktavaha srotas.

5. UDBHAVA STHANA73:

Aetiological factors cause vitiation of Dosha and the place through which they sprout is

called Udbhava sthana. Pandu being an Amashaya samuttha vyadhi, after reaching to

Hridaya (Strotomula) the Doshas spreads throughout body.

6. SANCHARA STHANA74:

After spreading from the Udbhava sthana it all depends on the route through which the

Doshas spread. This decides the systemic involvement and the disease in particular. This is

further decided by the Nidana sevana and status of the system. In Pandu, Sanchara is

through the Dasha dhamanis.




7. ASHRAYA75:

In Pandu, the Doshas take Ashraya between Twak and Mamsa thereby causing vitiation of

different Dhatus and producing different Varnas.

UPADRAVA76

This is the stage of complication of main disease. The main or primary disease in the due

course of time or kala proceeds further and as a result of indulgence in dosha prakopaka

ahara vihara leads to upadrava.

The following have been mentioned as upadrava of Pandu Roga:

1. Aruchi 11. Hridaya peedana

2. Pipasa 12. Shwasa

3. Jwara 13. Atisara

4. Moordharuja 14. Trasa

5. Agnisada 15. Shoola

6. Sopha 16. Daha

7. Chardi 17. Avipaka

8. Avalatwam 18. Swarabhedha

9. Moorcha 19. Swarasada

10. Klama 20. Shotha

Table No. : 12




Showing Upadrava of pandu Roga

Sl. no. Lakshana S.S A.H.

1 Aruchi + -

2 Pipasa + -

3 Chardi + -

4 Jwara + -

5 Shiroruja + -

6 Agnisada + -

7 Shopha + +

8 Kantagata abalatwam + -

9 Moorcha + -

10 Klama + -

11 Hrdaya avapeedanam + -

12 Shwasa + -

13 Atisara + -

14 Kasa + -

15 Daha + -

16 Avipaka + -

17 Swarabheda + -

18 Sada + -

19 Adhmana - -

20 Tandra - -

21 Pandu danta - -

22 Pandu nakha - -

23 Pandu netra - -




MODERN ASPECT

HISTORY77:

The first person to describe Red blood cells was the Dutch biologist Jan Swammerdam who

had used an early microscope in 1658 to study the blood of frog. Unaware of this work,

Anton van Leeuwenhoek provided another microscope description in 1674, also described the

size and shape of “red corpuscles.” Even approximating the size of RBC, 25,000 times

smaller than a fine grain of sand.

ERYTHROPOEISIS78,79,80

It is the process of production of RBC’s. Erythropoeisis starts with a big, nucleated cell called

haemocytoblast which becomes CFU-E, differentiates into PROERYTHROBLAST- RBC

precursor and become a mature RBC at the end of 7-8 days which is a small, non- nucleated

and with Hb.

SITES OF ERYTHROPOISIS

IN FOETAL LIFE-

1. MESOBLASTIC STAGE- upto 3 months of foetal life, RBC’s are formed from

AREA VASCULOSA (mesodermal layer of yolk sac).

2. HEPATIC STAGE- after 3 month of foetal life, LIVER and SPLEEN will be primary

sites of Erythropoiesis.

3. MELOID STAGE- after 5th month, it occurs in bone marrow i.e, in all bones (with red

bone marrow) along with Liver and Spleen.

IN ADULTS-




RBC’s are produced exclusively in the BONE MARROW of adults.

STAGES OF ERYTHROPOEISIS

a) Proerythroblast : It is a big cell of diameter of 14-20 μm. There are several nucleoli in

the nucleous, which are round. The chromatin in the nucleous consists of red purple

strands. Proerythroblasts undergo rapid division and gives rise to basophilic

erythroblasts.

b) Early normoblasts : It is a round cell with the diameter of 12-16 μm, and have more

basophilic cytoplasm than the pro erythroblasts. It undergoes rapid proliferation. The

nucleous of the proerythroblasts have coarser and more basophilic chromatin strands.

c) Intermediate normoblast: It is a round cell between 12 – 14 μm in diameter. Nucleous

becomes much smaller and cells divide by Mitosis. Nuclear chromatin is in coarse,

deeply basophilic clumps, and proliferative activity ceases after this stages.

Heamoglobin starts to appear.

d) Late normoblast : diameter of cell is 8-10 μm nucleous becomes very small and it is

having INK SPOT nucleous. Quantity of Hb increases and cells stop dividing.

Cytoplasm becomes ACIDOPHILIC.

e) Reticulocyte : it is having a diameter of 7-8 μm, slightly larger than a mature RBC.

Cytoplasm is deeply stained with Acidophilic cytoplasm. The amount of Hb increases.

The cytoplasm contains a reticulum network which is formed by the remenants of RNA,

Mitochondria, Ribosomes and Endoplasmic reticulum. They enter the general circulation

through blood capillaries.

f) Erythrocyte: the diameter is about 7-8 μm. Nucleous and all cell organalles are absent.

Reticular network disappears and cell becomes RBC’s and attain biconcave shape.




Reticulocytes develop into mature RBC within 1-2 days after their release into general

circulation.

MORPHOLOGY AND FUNCTIONS OF THE RED BLOOD

CORPUSCLES81

Mature red cell is a circular, biconcave disc containing pigmented protein called heamoglobin

and is bound by the cell membrane. It is having a mean diameter of about 7.8 μm and

thickness of 2.5 micrometers. The shape of Cells can frequently change as they squeeze

through capillaries.

On peripheral smear, they appear as pale red cells with central one third pallor. The normal

range for young female adults is 12-16g/dL; for young male adults it is 14-18g/dL.

Life span: The mature erythrocyte has a life span of approximately 120 days in the

circulation. As red blood cells age, the surface area decreases relative to cytoplasmic volume

resulting in a sphere form which is more rigid and is ultimately trapped in splenic cords.

FUNCTIONS82:

1. They provide an environment for the iron-containing respiratory pigment, heme,

which is complexed to two alpha and two beta globin chains comprising the

hemoglobin molecule.

2. The major function of Red Blood cells, is to transport hemoglobin, which in turn

carries oxygen from the lungs to the tissues.




3. The erythrocyte also contains enzymes that participate in the glycolytic and hexose

monophosphate biochemical pathways. Under normal circumstances, red blood cells

never leave the circulatory system.

BLOOD PERIPHERAL SMEAR83

Examination of a fixed and stained blood film is an essential part of a haematological

investigation. The best place to examine blood cell morphology is the feathered edge of the

blood smear where red cells lie in a single layer, side by side, just barely touching one

another but not overlapping. Red cells are examined for:

1) Size

2) Shape

3) Color

SIZE:

1) Normocytes: Normal RBC is biconcave, 7.2 μm in diameter.

2) Microcytic: RBC’s are smaller than normal and less than 6 μm in diameter.

3) Macrocyte: Larger than normal, more than 9 μm.

SHAPE:

Red cells can take on a variety of different shapes. Some of the morphological abnormality

which is seen in RBC’s is:

1) Poikilocytes: these are abnormally shaped red cells are spherocytes: Small red cells

without the central pallor, they can be seen in hereditary spherocytosis.

2) Dacrocytes: are teardrop- shaped cells. It is also called pear shaped cell.

3) Schistocytes: are small, irregular, triangular or speculated cells. Also called as

helmet-shaped cells.




4) Echinocytes: are very small, irregular shrunken cells with pointed projections. These

resembles to small thorny ‘burrs’.

5) Acanthocytes: are Irregularly crenated cells with irregularly spaced sharp projections.

6) Small number of spicules of length, thickness, shape, irregularly disposed over the

surface of the cell.

7) Elliptocytes: are elliptical-shaped red cells that can reflect an inherited defect in the

red cell membrane.

8) Stomatocytes: these are red cells in which the area of central pallor

takes on the morphology of a slit instead of the usual round shape.

9) Spherocytes: small densely staining spherical red cells with no central pallor area.

10) Ovalocytes: these are oval shaped red cells. About 10% RBC in a normal blood film,

particularly at the tail end, appear oval and less commonly elliptical in shape.

11) Sickle Cells: thin, elongated, slightly curved and have shape of sickle.

CHROMASIA:

1) Normochromic: Cells with central 1/3 pallor.

2) Hypochromic: Cells with more than 1/3 central pallor.

3) Polychromic: Cells stained purple and are larger than normal.

STAINS FOR BLOOD SMEARS84

The blood cells contain cellular structures which vary in their pH, some are acidic and others

are basic.

All stains which are made up of combinations of acidic and basic dyes are called

Romanowsky stains.

Romanowsky Stains




It is a mixture of methylene blue (basic stain) and eosin (acoidic stain). Methylene blue on

oxidation produces colored compounds called Azures that have the ability to combine with

eosin. Oxidation is achieved during maturation/chemical treatment of the stain. The Azures

are responsible for different shades of staining in the smears ( i.e RBC’s pink, granules of

eosinophils red- orange, granules of basophils bluish black, granules of neutrophil- iliac).

Leishman stain comes under Romanowsky stains. It contains Leishman powder and acetone

free Methyl Alcohol (Methanol)

METHOD OF PREPARING STAIN

Blood peripheral smear will be done by using Lieshman’s stain, as it provides excellent stain

quality.

* Leishman stain comes in a dry powder form.

* This dry powder is to be mixed well into good quality anhydrous methanol in ratio of

0.6gm powder into 400ml methanol.

* The stain (usually 50-100 ml) should be filtered into a dispensing unit.

PREPRATION OF THE PERIPHERAL OF BLOOD SMEAR85

1) A drop of blood is obtained by capillary puncture and it is placed about 1cm from the end

of a grease free slide.

2) A spreader slide is held between thumb and fingers of the right hand at an angle of about

40 degree to the horizontal.

3) A thin layer of blood is obtained and the slide is air dried.

4) About 8-10 drops of lieshman’s stain is dropped over the dried slide using a dropper such

that the stain covers the entire surface of the slide and time is noted.

5) The slide is left undisturbed for two minutes.




6) Distilled water is added drop by drop till it covers the entire slide surface. The stain and

distilled water are mixed by blowing through a glass tube. This is allowed to stand for 8

minutes.

7) After the stipulated time, the mixture is poured off and slide is washed with running water

and air dried.

8) The slide can be viewed under the microscope first under 10X and then under oil

immersion 100X.

FEATURES OF WELL MADE SMEAR86

Length: smear should be 2/3 to ¾ of the length of the slide.

Shape: the smear should be either tongue or finger- shaped (smooth without any

irregularities or holes)

Well made smear has three parts namely head, body, and tail.

FIXATION OF THE SMEAR

The blood should be fixed within 4 hours for good staining.

Blood films are fixed by acetone free methyl alcohol which is present in Leishman

stain, Wright or Giemsa stain.

NORMAL PICTURE OF WELL STAINED SMEAR87

In a well stained peripheral blood smear:

COLOR: Rose pink smear

RBCs: Orange to salmon pink

NEUTROPHILIS: Deep purple nucleus, liliac cytoplasm, barely visible granules.

EOSINOPHILS: 2-3 thick lobes of nucleus, bright orange granule.

EXAMINATION OF PERIPHERAL BLOOD SMEAR88




The best area of the smear to study the morphology of cells is the body, where the cells are

well separated out and touch one another without overlapping. Apply a thin layer of Cedar

wood oil over the smear which makes the appearance of cells very clear. First slides are

viewed under low power (10X), followed by high power (100X) and following observations

are noted:

1. The quality of the film and uniformity of staining.

2. Red Blood Cells: Red cells examination can be best noticed between the tail and

body of the smear where those are evenly placed and just touch each other. Look for

number, distribution and staining of the red cells, degree of Rouleaux formation if

present.

3. Likewise, White Blood Cells, Platelets, Hemoparasites should be observed.




METHODOLOGY

Source of data:

50 patients, both male and female, of the age between 16 to 60 yrs, attending O.P.D, I.P.D of

JSS Ayurveda Medical College and Hospital, Mysuru. Special camps were held at JSS

School and degree college, Sutturu, NSS camp at Bidargudu, JSS College for Women,

Saraswathipuram. Subjects were selected at random without bias of social, economic,

educational or religious status.

METHOD OF COLLECTION DATA:

a) Sample size: 50 subjects were selected for this study.

b) Diagnostic criteria:

Through detail history of patients who were having Pratyatma lakshana of Pandu roga

(Panduta) was done and patients were screened for the following Samanya lakshanas of Pandu

roga.

Twak vaivarnayata (pale skin color)

Anna dwesha (aversion to food)

Alpa vak (diminished speech)

Hatanala (loss of digestion)

Nidralu (oversleep)

Shuna akshi koota (peri orbit swellings)

Anga Sada (malaise)




Shtivana (spitting)

Kopana (irritability)

Shishira dweshi (aversion to cold)

Sheerna loma (falling of hairs)

Jwara (fever)

Shwasa (dyspnoea)

Karna kshwedi (tinnitus)

Bhrama (giddiness)

Shrama (exhaustion)

Hataprabha (loss of luster)

Durbala (debility)

Pindikodweshtana (cramps)

Kati, uru, pada ruk (pain in waist, thigh, legs)

Sadana (lassitude)

Arohana ayasa (exertional dyspnoea)

Those patients were assessed for Vishista lakshana of Pandu roga mentioned in various classics

to diagnose the type of Pandu roga. Later patients were subjected to Peripheral Blood Smear

through capillary puncture and smear was studied under 100X oil immersion microscope.

c) Inclusion criteria:

Patients of either sex.

Patients of 16 – 60 years of age.

The individual having the clinical features of pandu roga ( samanya lakshanas of pandu)




d) Exclusion criteria:

Patients with history of metabolic disorders.

Patients with history of congenital disorders related with haemopoetic system like sickle

cell anemia, leukemia, hemophilia.

Patients suffering with any infectious diseases like malaria

Gastro intestinal bleeding.

Pregnant.

Drug induced anemia.

Recent blood donation.

Acute and chronic illness.

Alcoholic patients.

Study design:

1) Patients fulfilling the inclusion criteria were selected.

2) The diagnosis of the type of Pandu roga present was done based on the Vishista

Lakshanas.

3) Patients were then subjected to blood peripheral smear.

4) Smear was stained with Leishman stain and slides were observed for the RBC

morphology under oil immersion (100X) microscope.

5) Findings were statistically analysed.




ASSESSMENT CRITERIA

SUBJECTIVE PARAMETERS:

Samanya lakshanas mentioned above.

Vishista Lakshanas mentioned in Pandu Roga are as follows:

Vataja Pandu lakshana:

Angamarda

Toda

Kampa

Krishna, ruksha, aruna sira

Nakha vin mutra netra

Shopha

Anaaha

Aasya vairasya

Varcha sosha

Parshva shola

Shiro ruja

Balakshaya

Ruja

Bhrama




Pittaja pandu lakshana:

Peeta / harita varna

Jwara

Daha

Trishna

Murchha

Peeta mutra, vin, nakha

Peeta sira

Sweda

Sheeta iccha

Dourgandhya

Katu asya

Varcha bheda

Amla udgara

Vidaha

Vidagdha anna

Dourbalya

Tama

Kaphaja pandu lakshana:

Gourava

Tandra

Chardi

Shvetaabhasa




Praseka

Lomaharsha

Sada

Murchha

Bhrama

Klama

Shwasa

Kasa

Aalasya

Aruchi

Vak swara graha

Shukla mutra akshi varchas

Katu ruksha ushna kamta

Shvaythu

Madhura asya

Swara kshaya

Tridoshaja pandu lakshana:

Tandra

Aalasya

Shwayathu

Vamathu

Kasa

Hrillasa




Shosha

Netra parusha

Jwara

Kshudha

Moha

Trishna

Klama

OBJECTIVE PARAMETERS89,90:

Peripheral blood smear. 5 fields (100X) oil emersion were observed in each slide. For the

morphology of RBCs range was given for the size and chromasia as :

1. 5- 25% (10-50 cells) - few

2. 25-50% (51-100 cells) - moderate

3. >50% (>100 cells) - many

Range given for abnormal shape of RBCs as:

1. 1-2 cells per field - few

2. 3-5 cells per field - moderate

3. >5 cells per field - many

METHOD OF PREPARING STAIN

Blood peripheral smear will be done by using Lieshman’s stain, as it provides

excellent stain quality.

Leishman stain comes in a dry powder form.




This dry powder is to be mixed well into good quality anhydrous methanol in

ratio of 0.6gm powder into 400ml methanol.

The stain (usually 50-100ml) should be filtered into a dispensing unit.

METHOD OF STAINING OF BLOOD FILM

1) A drop of blood is obtained by capillary puncture and it is placed about 1cm

from the end of a grease free slide.

2) A spreader slide is held between thumb and fingers of the right hand at an

angle of about 40 degree to the horizontal.

3) A thin layer of blood is obtained and the slide is air dried.

4) About 8-10 drops of lieshman’s stain is dropped over the dried slide using a

dropper such that the stain covers the entire surface of the slide and time is noted.

5) The slide is left undisturbed for two minutes.

6) Distilled water is added drop by drop till it covers the entire slide surface. The

stain and distilled water are mixed by blowing through a glass tube. This is

allowed to stand for 8 minutes.

7) After the stipulated time, the mixture is poured off and slide is washed with

running water and air dried.

8) The slides were viewed under the microscope first under 10X and then under

oil immersion 100X.




RESULTS

Table-13: Distribution of Subjects according to Age

Age, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

< 16 3 6.0 6.0 6.0

17 - 30 31 62.0 62.0 68.0

31 - 60 16 32.0 32.0 100.0

Total 50 100.0 100.0

Graph -1: showing Distribution of Subjects according to Age

The above table showed that the majority of study population belonged to 17- 30 years

(62%), followed by age group of 31-60 years (32%). The least are below the age of 16years

(6%).

0

5

10

15

20

25

30

35

Less than 16 17 to 30 31 to 60

Frequency 3 31 16

AGE, n=50




Table-14: Distribution of subjects according to the Gender

GENDER, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Female 44 88.0 88.0 88.0

Male 6 12.0 12.0 100.0

Total 50 100.0 100.0

Graph -2: showing Distribution of Subjects according to gender

Amongst the 50 subjects, the highest incidence i.e. 44 (88%) was in females, followed by

male 6 (12%).

0

10

20

30

40

50

feMale male

Frequency 44 6

GENDER, n=50




Table-15: Distribution of subjects according to the locality

LOCALITY, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Urban 28 56.0 56.0 56.0

Rural 22 44.0 44.0 100.0

Total 50 100.0 100.0

Graph -3: showing Distribution of Subjects according to locality

The above table shows that majority of the study population 28(56%) belonged to urban

place, and 18 (44%) belonged to rural place.

56%

44%

LOCALITY, n=50

urban

rural




Table-16: Distribution of subjects according to the religion

RELIGION, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Hindu 48 96.0 96.0 96.0

Muslim 1 2.0 2.0 98.0

Christian 1 2.0 2.0 100.0

Total 50 100.0 100.0

Graph -4: showing Distribution of Subjects according to religion

Among 50 subjects, highest number i.e. 96% (48) was Hindus, 2% (1) was Muslim,

2% (1) was Christian.

0

10

20

30

40

50

Hindu Muslim Christian

Frequency 48 1 1

RELIGION, n=50




Table-17: Distribution of subjects according to the marital status

MARITAL STATUS, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Married 19 38.0 38.0 38.0

Unmarried 28 56.0 56.0 94.0

Widow 3 6.0 6.0 100.0

Total 50 100.0 100.0

Graph -5: showing Distribution of Subjects according to marital status

The above table shows that majority of subjects were unmarried 28(56%) and 28(38%) of

subjects were married. And 3( 6%)were widows.

Married Unmarried Widow

Frequency 19 28 3

0

5

10

15

20

25

30

MARITAL STATUS, n=50




Table-18: Distribution of subjects according to the educational status

EDUCATIONAL STATUS, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Uneducated 4 8.0 8.0 8.0

Primary 6 12.0 12.0 20.0

High school 3 6.0 6.0 26.0

PUC /diploma 9 18.0 18.0 44.0

Graduate 19 38.0 38.0 82.0

Postgraduate 9 18.0 18.0 100.0

Total 50 100.0 100.0

8%

12%

6%

18%38%

18%

EDUCATIONAL STATUS, n=50

Uneducated

primary

highschool

puc/diploma

graduate

postgraduate




Graph -6: showing Distribution of Subjects according to educational status

Amongst 50 subjects, 38% (19) were Graduates, 18% (9) subjects were PUC/diploma and

postgraduates, 12% (6) were having primary Education, whereas 8% (4) and 6% (3) were

uneducated and high school respectively.

Table-19: Distribution of subjects according to the Socio economic status

Socio Economic Status

Frequency Percent

Valid

Percent

Cumulative

Percent

Poor 7 14.0 14.0 14.0

Lower

middle

8 16.0 16.0 30.0

Upper

middle

23 46.0 46.0 76.0

Rich 12 24.0 24.0 100.0

Total 50 100.0 100.0




Graph -7: showing Distribution of Subjects according to socio-economic status

Amongst 50 subjects, 46%(23) belonged to upper middle class, 24% (12) belonged to rich

class, 16%(8) belonged to lower middle and 14% (7) were poor.

Table-20: Distribution of subjects according to the Diet

DIET, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Vegetarian 30 60.0 60.0 60.0

Mixed 20 40.0 40.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

poor lowermiddle

uppermiddle

rich

SOCIO ECONOMIC STATUS, n=50

Frequency




Graph -8: showing Distribution of Subjects according to diet

Amongst 50 subjects, 60% (30) were vegetarians, whereas 40% (20) were on mixed

diet.

Table-21: Distribution of subjects according to the appetite

APPETITE, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Increased 2 4.0 4.0 4.0

Reduced 37 74.0 74.0 78.0

Not

altered

11 22.0 22.0 100.0

Total 50 100.0 100.0

60%

40%

DIET n=50

vegetarian

mixed




Graph -9`: showing Distribution of Subjects according to appetite

Amongst 50 subjects, 74% (37) were having reduced appetite, 22% (11) appetite was not

altered and 4% (2) appetite was increased.

Table-22: Distribution of subjects according to the night sleep

night sleep

Frequency Percent

Valid

Percent

Cumulative

Percent

sound 34 68.0 68.0 68.0

disturbed 16 32.0 32.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

30

35

40

increased reduced not altered

Frequency 2 37 11

APPETITE, n=50




Graph -10: showing Distribution of Subjects according to night sleep

Amongst 50 subjects, 66% (33) were having sound night sleep whereas 34% (17) were

having disturbed night sleep.

Table -23: showing Distribution of Subjects according to day sleep

DAY SLEEP, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

present 11 22.0 22.0 22.0

absent 39 78.0 78.0 98.0

Total 50 100.0 100.0

68%

32%

NIGHT SLEEP, n=50

sound

disturbed




Graph -11: showing Distribution of Subjects according to day sleep

Amongst 50 subjects, 78% (36) were habituated for day sleep, 22% (11) were not sleeping in

day time.

Table-24: Distribution of subjects according to the bowel (consistency)

BOWEL/CONSISTENCY, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Hard 15 30.0 30.0 30.0

Soft 34 68.0 68.0 98.0

Loose 1 2.0 2.0 100.0

Total 50 100.0 100.0

22%

78%

DAY SLEEP, n=50

absent

present




Graph -12: showing Distribution of Subjects according to bowel consistency

Amongst 50 subjects, 68% (34) were having soft bowel consistency, 30% (15) were having

hard bowel consistency, and 2% (1) were having loose bowel consistency.

Table-25: Distribution of subjects according to the tea consumption

TEA, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Present 37 74.0 74.0 74.0

Absent 13 26.0 26.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

30

35

hard soft loose

Frequency 15 34 1

BOWEL CONSISTENCY, n=50




Graph -13: showing Distribution of Subjects according to tea consumption

Amongst 50 subjects, 74% (37) were habituated for tea consumption and 26% (13) were not

habituated for tea.

Table-26: Distribution of subjects according to the coffee consumption

COFFEE, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Present 12 24.0 24.0 24.0

Absent 38 76.0 76.0 100.0

Total 50 100.0 100.0

74%

26%

TEA, n=50

present

absent




Graph -14: showing Distribution of Subjects according to coffee consumption

Amongst 50 subjects, 76% (38) were not taking coffee whereas 24% (12) were taking coffee.

Table-27: Distribution of subjects according to the smoking

SMOKING, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Present 4 8.0 8.0 8.0

Absent 46 92.0 92.0 100.0

Total 50 100.0 100.0

24%

76%

COFFEE, n=50

present

absent




Graph -15: showing Distribution of Subjects according to smoking

Amongst 50 subjects, 92% (46) were nonsmokers whereas 8% (4) were smokers.

Table-28: Distribution of subjects according to the Alcohol

ALCOHOL, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Present 3 6.0 6.0 6.0

Absent 47 94.0 94.0 100.0

Total 50 100.0 100.0

0

10

20

30

40

50

present absent

SMOKING, n=50

Frequency




Graph -16: showing Distribution of Subjects according to alcohol consumption

Amongst 50 subjects, 94% (47) were nonalcoholic whereas 6% (3) were alcoholic.

Table-29: Distribution of subjects according to the type of work

TYPE OF WORK, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Sedentary 40 80.0 80.0 80.0

Moderate 7 14.0 14.0 94.0

Heavy 3 6.0 6.0 100.0

Total 50 100.0 100.0

present absent

Frequency 3 47

0

5

10

15

20

25

30

35

40

45

50

ALCOHOL, n=50




Graph -17: showing Distribution of Subjects according to type of work

Amongst 50 subjects, 80% (40) were having sedentary work, 14% (7) were having moderate

work and 6% (3) were having heavy work.

Table-30: Distribution of subjects according to the time of work

Time Of Work, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Day 41 82.0 82.0 82.0

Night 1 2.0 2.0 84.0

Day&

night

8 16.0 16.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

30

35

40

sedentary moderate heavy

Frequency 40 7 3

TYPE OF WORK, n=50




Graph -18: showing distribution of Subjects according to time of work

Amongst 50 subjects, 82% (41) were day workers, 16% (8) were day and night workers

whereas 2% (1) was doing night shifts.

Table-31: Distribution of subjects according to the nature of cycles

Nature of cycle

Frequency Percent

Valid

Percent

Cumulative

Percent

no 6 12.0 12.0 12.0

Regular 34 68.0 68.0 80.0

Irregular 10 20.0 20.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

30

35

40

45

day night day & night

Frequency 41 1 8

TIME OF WORK, n=50




Graph -19: showing distribution of Subjects according to nature of cycle

Amongst 50 subjects, 44 were females, 68% (34) were having regular menstrual cycles

whereas 20% (10) were having irregular menstrual cycle.

Table-32: Distribution of subjects according to the Quantity

Quantity

Frequency Percent

Valid

Percent

Cumulative

Percent

No 6 12.0 12.0 12.0

Heavy 12 24.0 24.0 36.0

Scanty 9 18.0 18.0 54.0

Moderate 23 46.0 46.0 100.0

Total 50 100.0 100.0

05

101520253035

34 10

regular irregular

Frequency 34 10

NATURE OF CYCLE, n =50




Graph -20: showing distribution of Subjects according to quantity

Amongst 50 subjects, 44 were females, 46% (23) were having moderate menstrual flow, 24%

(12) were having heavy menstrual flow, and 18% (9) were having scanty flow. Remaining 6

subjects were males.

Table-33: Distribution of subjects according to the clots

clots

Frequency Percent

Valid

Percent

Cumulative

Percent

No 6 12.0 12.0 12.0

Present 20 40.0 40.0 52.0

Absent 24 48.0 48.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

heavy scany moderate

Frequency 12 9 23

QUANTITY, n=50




Graph -21: showing distribution of Subjects according to clots

Amongst 50 subjects, 44 were females, 48% (24) were not having clots in menstrual cycles,

whereas 40% (20) were having clots. Remaining 6 were males.

Table-34: Distribution of subjects according to the nourishment

NOURISHMENT, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Poor 35 70.0 70.0 70.0

Well 14 28.0 28.0 98.0

Over 1 2.0 2.0 100.0

Total 50 100.0 100.0

18

19

20

21

22

23

24

20 24

present absent

Frequency 20 24

CLOTS , n=50




Graph -22: showing distribution of Subjects according to nourishment

Amongst 50 subjects, 70% (35) were poorly nourished, 28% (14) were moderately nourished

and 2% (1) was over nourished

Table-35: Distribution of subjects according to the nadi

NADI, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Vata 11 22.0 22.0 22.0

Pitta 34 68.0 68.0 90.0

Kapha 5 10.0 10.0 100.0

Total 50 100.0 100.0

malnourished well norished over nourished

Frequency 35 14 1

0

5

10

15

20

25

30

35

40

NOURISHMENT, n=50




Graph -23: showing distribution of Subjects according to nadi

Amongst 50 subjects, 68% (34) were having pittaja nadi, 22% (11) were having Vataja nadi

and 10% (5) was having Kaphaja nadi.

Table-36: Distribution of subjects according to the Sparsha

SPARSHA, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

Cold&

rough

16 32.0 32.0 32.0

Hot &

moist

8 16.0 16.0 48.0

Wet &

cold

26 52.0 52.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

30

35

vata pitta kapha

Frequency 11 34 5

NADI, n=50




Graph -24: showing distribution of Subjects according to sparsha

Amongst 50 subjects, 52% (26) were having wet & cold touch, 32% (11) were having cold &

rough touch and 16% (8) was having Hot & moist touch.

Table-37: Distribution of subjects according to the Akruti

Akruti

Frequency Percent

Valid

Percent

Cumulative

Percent

Krusha 36 72.0 72.0 72.0

Madhayama 13 26.0 26.0 98.0

Sthoola 1 2.0 2.0 100.0

Total 50 100.0 100.0

32%

16%

52%

SPARSHA, n=50

1

2

3




Graph -25: showing distribution of Subjects according to Akruti

Amongst 50 subjects, 72% (36) were having krusha akruti, 26% (13) were having

madhayama akruti and 2% (1) was having sthoola akruti.

Table-37: Distribution of subjects according to the Prakruti

PRAKRUTI, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

vata pitta 30 60.0 60.0 60.0

pittakapha 7 14.0 14.0 74.0

vata kapha 13 26.0 26.0 100.0

Total 50 100.0 100.0

72%

26%

2%

AKRUTI, n=50

krusha

madhayama

sthoola




Graph -26: showing distribution of Subjects according to prakruti

Amongst 50 subjects, 60% (30) were having vata-pitta prakriti, 26% (13) were having vata-

kapha prakriti and 14% (7) were having pitta-kapha prakriti.

Table-38: Distribution of subjects according to the sara

SARA, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

madhayama 38 76.0 76.0 76.0

avara 12 24.0 24.0 100.0

Total 50 100.0 100.0

vata pitta pittakapha vata kapha

Frequency 30 7 13

0

5

10

15

20

25

30

35

PRAKRUTI, n=50




Graph -27: showing distribution of Subjects according to sara

Amongst 50 subjects, 76% (38) were having madhayama sara and 24% (12) were having

avara sara.

Table-39: Distribution of subjects according to the Samhanana

Samhanana

Frequency Percent

Valid

Percent

Cumulative

Percent

madhayama 48 96.0 96.0 96.0

avara 2 4.0 4.0 100.0

Total 50 100.0 100.0

0

10

20

30

40

madhayama avara

Frequency 38 12

SARA, n=50




Graph -28: showing distribution of Subjects according to samhanana

Amongst 50 subjects, 96% (48) were having madhayama samhanana and 4% (2) were having

avara samhanana.

Table-40: Distribution of subjects according to the Pramana

Pramana

Frequency Percent

Valid

Percent

Cumulative

Percent

pravara 1 2.0 2.0 2.0

madhayama 25 50.0 50.0 52.0

avara 24 48.0 48.0 100.0

Total 50 100.0 100.0

0

10

20

30

40

50

madhayama avara

Frequency 48 2

48

2

SAMHANANA, n=50




Graph -29: showing distribution of Subjects according to pramana

Amongst 50 subjects, 50% (24) were having madhayama pramana and 48% (24) were having

avara pramana.

Table-41: Distribution of subjects according to the satva

SATVA, n=50

Frequency Percent

Valid

Percent

Cumulative

Percent

pravara 1 2.0 2.0 2.0

madhyama 44 88.0 88.0 90.0

avara 5 10.0 10.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

pravara madhayama avara

1

25 24

PRAMANA, n=50

Frequency




Graph -30: showing distribution of Subjects according to satva

Amongst 50 subjects, 88% (44) were having madhayama satva and 10% (5) were having

avara satva.

Table-42: Distribution of subjects according to the Abhyavarana shakti

Abhyavarana Shakti

Frequency Percent

Valid

Percent

Cumulative

Percent

pravara 2 4.0 4.0 4.0

madhyama 32 64.0 64.0 68.0

avara 16 32.0 32.0 100.0

Total 50 100.0 100.0

2%

88%

10%

SATVA, n=50

pravara

madhyama

avara




Graph -31: showing distribution of Subjects according to Abhyavarana Shakti

Amongst 50 subjects, 64% (32) were having madhayama Abhyavarana shakti

and 32% (16) were having avara Abhyavarana Shakti and 4%(2) were having pravara

Abhyavarana Shakti.

Table-43: Distribution of subjects according to the Jarana shakti

Jarana shakti

Frequency Percent

Valid

Percent

Cumulative

Percent

pravara 2 4.0 4.0 4.0

madhyama 28 56.0 56.0 60.0

avara 20 40.0 40.0 100.0

Total 50 100.0 100.0

pravara madhyama avara

Frequency 2 32 16

0

5

10

15

20

25

30

35

ABHYAVARANA SHAKTI, n=50




Graph -32: showing distribution of Subjects according to Jarana Shakti

Amongst 50 subjects, 56% (28) were having madhayama jarana shakti

and 20% (40) were having avara jarana shakti and 4%(2) were having pravara jarana shakti.

Table-44: Distribution of subjects according to the Vyayama shakti

Vyayama Shakti

Frequency Percent

Valid

Percent

Cumulative

Percent

pravara 2 4.0 4.0 4.0

madhayma 32 64.0 64.0 68.0

avara 16 32.0 32.0 100.0

Total 50 100.0 100.0

0

5

10

15

20

25

30

pravara madhyama avara

JARANA SHAKTI, n=50

Frequency




Graph -33: showing distribution of Subjects according to Vyayama Shakti

Amongst 50 subjects, 64% (32) were having madhayama Vyayama shakti and 32% (16) were

having avara Vyayama shakti and 4% (2) were having pravara Vyayama Shakti.

2

32

16

0

5

10

15

20

25

30

35

pravara madhayma avara

VYAYAMA SHAKTI, n=50

Frequency




Graph -34: Distribution of subjects showing Aharaja nidanas

Amongst 50 subjects, more predominantly aharaja nidanas were Ati lavana (98%), excessive

use of Masha (90%), Nishpava (90%), Ati tikshna (72%), Ati ushna (64%), viruddha ahara

(62%), katu (58%), amla (58%).

0% 20% 40% 60% 80% 100%

KSHARA

LAVANA

KATU

KASHAYA

ATI TIKSHNA

ATI USHNA

VIRUDDHA

VIDAGDHA

ASATMAYA

NISHAPAVA

MASHA

TILA TAILA

MADHYA

AMLA

MRITTIKA BHAKSHANA

0%

98%

58%

22%

72%

64%

62%

10%

20%

90%

90%

8%

14%

58%

32%

AHARAJA NIDANAS, n=50

present




Graph -35: distribution of subjects showing viharaja nidanas

Amongst 50 subjects, more predominantly viharaja nidanas were Diwaswapna (72%), Shrama

(70%), Nidra nasha (56%)

0% 20% 40% 60% 80%

DIVASWAPNA

VYAYAMA

MAITHUNA

PANCHAKARMA VAISHMYA

RUTU VAISHMYA

NIDRA NASHA

SHRAMA

VEGA VIDHARANA

72%

28%

24%

0%

26%

56%

70%

34%

VIHARAJA NIDANA, n=50

present




Graph -36: distribution of subjects showing manasika nidanas

Amongst 50 subjects, more predominantly manasika nidanas were chinta (70%), krodha

(66%), bhaya (44%).

0%

10%

20%

30%

40%

50%

60%

70%

44%

70%66%

14% 16%

MANASIKA NIDANAS, n=50

present




GRAPHS SHOWING VISHISHTA LAKSHANA OF PANDU

Graph -37: showing distribution of vataja pandu lakshana

Amongst 50 subjects, lakshanas which were commonly seen were Angamarda(80%), shiro

ruja (60%), balakshaya (48%).

0%10%20%30%40%50%60%70%80%

80%

4% 8%0% 4% 0%

8%14%

4%

16%

60%

48%

12%

44%

VATAJA PANDU LAKSHANA, n=50

PRESENT




Graph -38: showing distribution of pittja pandu lakshana

Amongst 50 subjects, lakshanas which were commonly seen are Dourbalya (74%), trishna

(24%), sweda (20%).

2% 6%16%

24%

6% 2% 4%

20% 16%

4% 2% 2%10%

4% 4%

74%

10%

0%10%20%30%40%50%60%70%80%

PITTAJA PANDU LAKSHANA, n=50

PRESENT




Graph -39: showing distribution of Kaphaja pandu lakshana

Amongst 50 subjects, lakshanas which were commonly seen were gourava (82%), aruchi

(80%), alasya (78%), tandra (74%), bhrama( 62%).

0%10%20%30%40%50%60%70%80%90%

GO

UR

AV

A

TAN

DR

A

CH

AR

DI

SHV

ETA

AB

HA

SA

PR

ASE

KA

LOM

AH

AR

SHA

SAD

A

MU

RC

HH

A

BH

RA

MA

KLA

MA

SHW

ASA

KA

SA

AA

LASY

A

AR

UC

HI

VA

K SW

AR

A G

RA

HA

SHU

KLA

MU

TRA

AK

SHI…

KA

TU R

UKS

HA

USH

NA

…

SHV

AYT

HU

MA

DH

UR

A A

SYA

SWA

RA

KSH

AYA

82%74%

22%26%

12%6%

12%20%

62%

4%

38%34%

78%80%

4% 4%14%

4% 6% 2%

KAPHAJA PANDU LAKSHANA, n=50

PRESENT




OBSERVATIONS

Amongst 50 subjects, 41 subjects were presenting with Kaphaja pandu lakshana, 3 subjects

were having more Vata-Pitta lakshana, 3 subjects were having more Vata-Kapha lakshana,

2 subjects found to have Vataja pandu lakshana, whereas 1 subject was having Pittaja

Pandu lakshana.

Table- 58: Distribution of subjects based on the color of RBC’s.

NORMOCHROMIC HYPOCHROMIC ABSENCE OF

CENTRAL PALOR

TOTAL

Frequency Percent

(%)

Frequency Percent

(%)

Frequency Percent

(%)

VATAJA 0 0.0 1 2.0 0 0.0 1

PITTAJA 0 0.0 1 2.0 0 0.0 1

KAPHAJA 0 0.0 42 84.0 0 0.0 42

VATA

PITTAJA

0 0.0 3 6.0 0 0.0 3

VATA

KAPHAJA

1 2.0 2 4.0 0 0.0 3

SANNIPATAJA 0 0.0 0 0.0 0 0.0 0

TOTAL 1 49 0 50




Graph 36: Showing distribution based on the chromasia(color) of RBC’s.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0% 0% 0% 0%2%

0%2% 2%

84%

6%4%

0%

NORMOCHROMIC

HYPOCHROMIC

ABSENCE OF CENTRAL PALOR




Table- 58: Distribution of subjects based on the Size of RBC’s.

NORMOCYTIC MICROCYTIC ANISOCYTIC TOTAL

Frequenc

y

Percent

(%)

Frequen

cy

Percent

(%)

frequency Percent

(%)

VATAJA 0 0.0 0 0.0 1 2.0 1

PITTAJA 0 0.0 0 2.0 1 0.0 1

KAPHAJA 6 4.0 27 84.0 9 2.0 42

VATA

PITTAJA

0 0.0 2 6.0 1 2.0 3

VATA

KAPHAJA

2 0.0 0 4.0 1 2.0 3

SANNIPATAJA 0 0.0 0 0.0 0 0.0 0

TOTAL 8 29 13 50




Graph 37: Showing distribution based on the Size of RBC’s.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0% 0%4%

0% 0% 0%0% 2%

84%

6%4% 0%

2% 0%2% 2% 2%

0%

NORMOCYTIC

MICROCYTIC

ANISOCYTIC




Table- 58: Distribution of subjects based on the Shape of RBC’s.

PANDU

TYPE

NORMA

L

ABNORMAL

TOT

AL

Freq

uenc

y

(%

age

)

poikiloc

yte

(%ag

e)

Burr

cells

(%ag

e)

Targ

et

cells

(%ag

e)

Dacroc

yte

(%ag

e)

VATAJA 1 2.

0

0 0.0 0 0.0 0 0.0 0 0.0 1

PITTAJA 1 2.

0

0 0.0 0 0.0 0 0.0 0 0.0 1

KAPHAJ

A

36 76

.0

1 2.0 1 2.0 3 9.0 1 2.0 42

VATA

PITTAJA

3 9.

0

0 0.0 0 0.0 0 0.0 0 0.0 3

VATA

KAPHAJ

A

2 9.

0

0 0.0 0 0.0 0 0.0 1 2.0 3

SANNIP

ATAJA

0 0.

0

0 0.0 0 0.0 0 0.0 0 0.0 0

TOTAL 43 1 1 3 2 50




Graph 38: Showing distribution based on the abnormal Shape of RBC’s

Amongst 50 subjects, 76% subject’s blood smear picture showed normal shape of the RBC’s,

whereas 2% presented with the poikilocyte, 2% presented with burrcells, 9% presented with

target cells and 2% presented with dacrocyte.

0%

10%

20%

30%

40%

50%

60%

70%

80% 76%

2%

2% 9%

2%

VATAJA

PITTAJA

KAPHAJA

VATA PITTAJA

VATA KAPHAJA

SANNIPATAJA




Table- 58: Distribution of subjects based on the presentation of size & Color

S.no Normocytic/

Normochromic

Normocytic/

hypochromic

Microcytic/

hypochromic

Anisocytic/

normochromic

Anisocytic/

hypochromic

Total

1. KAPHA 0 6 27 0 9 42

2. VATA

PITTA

0 0 2 0 1 3

3. VATA

KAPHA

0 2 0 1 0 3

4. PITTA 0 0 0 0 1 1

5. VATA 0 0 0 0 1 1

6. SANNIPATA 0 0 0 0 0 0

TOTAL 50




Graph 39: Showing distribution based on the Size & shape of RBC’s

Amongst 50 subjects, 42 subjects were having Kaphaja Pandu,

Out of that 27 subject’s blood picture showed Microcytic Hypochromic RBC’s.



Amongst 50 subjects, 3 subjects were having Vata Pitta pandu,

2 subject’s blood picture showed Microcytic Hypochromic RBC’s.


Amongst 50 subjects, 3 subjects were having Vata Kapha pandu,

1 subject’s blood picture showed Anisocytic Normochromic RBC’s


0

5

10

15

20

25

30

6

02

0 0 0

27

20 0 0 0

9

10

1 10

Normocytic/ Normochromic

Normocytic/ hypochromic

Microcytic/ hypochromic

Anisocytic/ normochromic

Anisocytic/ hypochromic





Amongst 50 subjects, 1 subject was having Vata pandu, blood picture blood picture


Amongst 50 subjects, 1 subject was having Pittaja pandu, blood picture blood picture


s




DISCUSSION

This is the most important part of any research work. It comprises the discussion of results

obtained from applied study. Discussion is the logical reasoning of observations. A rational

discussion alone helps in drawing a proper conclusion.

The present study is a diagnostic study on Pandu roga, in which the diagnosis was made

on the basis of Samanya and Vishista lakshanas and morphology of RBC’s was observed in

blood peripheral smear.

DISCUSSION ON OBSERVATION:

Incidence studies of the subjects are as follows –

Age incidence: Majority of patients in the study were in between the age 17 to 30 years

(62%) and 31 to 60 years (32%). This may be because of excessive physical strain, pre-

menopausal stage (where there is irregular and excessive menstruation) and also due to

their food habits and change in the lifestyle.

Sex incidence: Majority of the patients was females nearly about 88%; menstruating

females require more quantity of dietary iron supplement than males. This may be the

probable cause for maximum prevalence among the females.

Socio-economical incidence: Since majority of the study subjects were students, it was

observed that the upper middle class showed more percentage i.e. (46%) and rich class

showed (24%) than people with poor socio economic background. As the samples were

collected from the schools and colleges this might not be related. Lack of knowledge

about proper nutritious food, worm infestation and lifestyle may be the prime factor in

causation of the disease.




Marital incidence: About Marital status, 56% were unmarried and 38% were married. It

might not be related.

Religion Incidence: Study records larger number of Hindus (96%), when compared to

Muslim (02%) and Christian (02%) religions. Data reflects more on the geographical

predominance of a particular sector as Hindus being dominant in Mysuru.

Locality incidence: patients were more from urban area (56%) than rural area (44%).

This may be due to the lagging of time for proper food intake and lifestyle modification.

Educational Status: Majority of the subjects was graduates (38%) followed by

PUC/diploma and post graduates (18%), primary education (12%), followed by

uneducated (8%) and high school children (6%). Due to the change in the lifestyle,

mental stress, and lack of balanced diet it is more common in the students.

Incidence of habit: majority of the subjects had habit of taking tea (74%), followed by

coffee (24%). Some of the subjects were taking tea along with the food; this might be the

aggravating factor as some studies have emphasized that tea consumption hampers the

iron absorption, while people with adequate iron stores remain unaffected.

Sleep pattern: most of the subjects (72%) were habituated for excessive sleep at day

hours and were also taking at night. About (68%) were taking more than 8hours sleep in

night time. Diwaswapna leads to the aggravation of kapha dosha and it is one among the

nidana of Pandu roga .

Type of work: majority of the subjects (80%) were having sedentary type of work,

(14%) subjects were having moderate work pattern. It results in jatharaagni mandhya

and kapha vriddhi which in turn hampers the absorption of ahara.




Dietary incidence: Detail questioning was done during the study and observed that

patients suffered from Pandu roga were vegetarians (70%) and (30%) were on mixed

diet. Their food mainly comprised of less calorie diet, vegetables. Patients had the habit

of taking fried food, pickles, spicy food items and junk food items. In vegetarians, non-

heme iron is not as easily absorbed by the body as meat-based heme iron. This might be

the probable cause Pandu roga.

Exercise: Maximum i.e. (32%) were not doing any exercise, while (64%) patients were

occasionally doing exercise whereas only (4%) patients were doing exercise regularly.

The reason for this might be lack of time and busy life.

Bowel (consistency): In this study (68%) were having soft bowel, (30%) were having

constipated bowels and only (1%) were having loose bowel.

Built & nourishment: Maximum i.e. (80%) of subjects were poorly built, (70%) were

poorly nourished, where (18%) were well built and (28%) were well nourished. It shows

that the persons who are poor in built and nourishment will prone to have pandu roga.

Because improper nutrition leads to improper formation of Dhatus.

Nature & quantity of menstrual cycle: Majority of the study subjects were females and

it was observed that 20% (10) had irregular periods where 24% (12) had heavy flow. As

there will be excess loss of blood which may results in Pandu.




Discussion on Nidana:

In this study it was found that Aharaja, Viharaja and Manasika nidanas were

contributing and precipitating factors for the Pandu roga.

Aharaja nidanas like Ati lavana (98%), excessive use of Masha (90%), Nishpava (90%),

Ati tikshna (72%), Ati ushna (64%) were predominantly seen. With the change in

lifestyle, the readymade and easy to cook food have become more popular. This type of

ahara satisfies hunger but have less nutritive value.

Jatharagni mandhyata which was caused due to improper intake of Ahara, was

further vitiated by the above nidanas which lead to improper rasa dhatu formation and

uttarottara dhatus were affected.

Thus, improper diet and regime like excessive usage of Masha, Nishpava which

causes stroto sangha will vitiates kapha, and excessive use of amla, Lavana, which are

Rakta dushti karaka and Ojo kshaya karaka will vitiates the Pitta pradhana tridosha.

This resulted in jatharagni mandhyata. And later it resulted in improper formation of

Adhya dhatu i.e. Rasa dhatu due to Dhatwagni mandhaya. If Rasa itself is deficient then

Uttarotara dhatus will also be deficient, as Dhatu poshana nyayas explains that Rasa

dhatu being the Adhya dhatu will help in nourishment of the Uttarotara dhatus.

Viharaja nidanas like Diwaswapna (72%), Shrama (70%), Nidra nasha (56%),

vega dharana were some of the routine activities which were practiced.

Diwaswapna lead to kapha prakopa as it possesses abhishyandi guna it resulted

in rasa kshaya and it caused pandu.




Shrama and nidra nasha were caused due to the vata prakopa, leading to

jathragni mandhyata thus ended up in Rasa kshaya.

By doing vega dharana, vata gets vitiated and it may results in altered physiology

of gut thereby leading to impaired vata karma.

Manasika nidanas like chinta (70%), krodha (66%), bhaya (44%) would have

contributed to the Nidanas of Pandu roga which would have caused vitiation of all

the tridoshas. This might have affected the digestion, metabolism and assimilation

occurring inside the body. Even contemporary science has explored role of mental

stress behind almost all diseases.

Discussion on Lakshana:

In the present study, the lakshanas of kaphaja pandu were predominantly seen.

Symptoms like Gourava (82%), Tandra (74%), Bhrama (62%), Shwasa (38%), Aalasya

(78%), Aruchi (80%) etc. were found in the majority of the subjects. It might be due to

the kapha prakopa, mainly because of aharaja nidanas like excessive usage of Masha

and Nishpava and Viharas like excessive indulgence in Diwaswapna.

Most of the features of Vataja pandu like Angamarda (80%), Shiro ruja (60%),

Balakshaya(48%), Bhrama (62%) were found. This might have caused due to Vata

prakopaka ahara & vihara.

Amongst Pittaja Pandu lakshanas like Dourbalya (74%), Trishna (24%) and

Sweda (20%) were also observed in some subjects. This might be due to the Pitta

prakopaka ahara & vihara.




In this study though Vata-pitta pandu & Vata kapha pandu have not been

mentioned separately but Vata pradhana piitaja pandu was also seen with the

predominance of both Vata and Pitta pandu lakshanas. And cases of Vata pradhana

kaphaja pandu were also found in this study with the predominance of both Vata as well

as Kapha pandu symptoms.

Discussion on blood peripheral smear findings:

Along with the pratyatma lakshana i.e. Panduta and samanya lakshana of of Pandu roga

majority of the subjects ( %) with the vishista lakshana of kaphaja pandu lakshana the

capillary blood of these subjects were subjected to the peripheral smear, stained and

examined through the 100X oil immersion microscope. The RBC’s morphology

predominantly was Microcytic hypochromic (%). This might be due to the predominance of

Kapha which could have resulted in Rasa dushti and Stroto sangha resulting in the

Uttarottara dhatu kshaya.

Microcytosis is the reduction in the size and hypochromia is the reduction in the color of

RBC’s than normalcy. RBC’s carry oxygen to all the tissues and thus sustain the tisuues.

This can be said as Dharana karma. So RBC’s can be considered as Dhatus.

The morphology of RBC’s the peripheral blood smear of the subjects of Kaphaja pandu

showed microcytosis i.e reduction in the size and hypochromia reduction in the colour. This

reduction may be considered as Dhatu kshaya as there is reduction in its normal size and

reduction in the physiological constituents. Dusta kapha causing stroto sangha might end up

in Dhatu kshaya leading to microcytic hypochromic RBC’s picture in peripheral blood

smear.




Few cases of Kaphaja pandu (9%) also showed Anisocytosis i.e. abnormal variation in

shape of RBC’s which can be understood as Dusta kapha leading to stroto sangha and

reduced Dhatu poshana ending up in Dhatu kshaya with abnormal morphological changes.

When stroto dusti in terms of Sangha is partial, the RBC’s have picture of normocytosis

(normal size) with reduced red color (hypochromia).

Subjects with clinical picture of Vata kaphaja pandu, though very less in number (9%)

have RBC’s picture of Anisocytosis hypochromic & Anisocytosis normoytic which gives a

mixed picture, the cause which can be related to Samprapti of kapha dusti leading to Dhatu

kshaya.




CONCLUSION

• Among the population studied, Kaphaja Pandu is being commonly found than other

types of Pandu. As the main cause of this is sedentary lifestyle and irregular food

habits.

• Among Kaphaja Pandu lakshanas most predominantly seen are Gourava, Tandra,

Aruchi, Alasya. In Pittaja Pandu lakshanas like Trishna, Daha and Murchha are

commonly seen. Similarly in Vataja Pandu lakshanas like Angamarda, Shiroshoola,

Parshvashoola are commonly seen.

• Kaphaja pandu being more commonly seen among the studied subjects, their

peripheral blood smear showed Microcytic Hypochromic and also Anisocytic

hypochromic RBC picture. If we get the blood picture of Microcytic Hypochromic &

Anisocytic hypochromic it can be considered as Kaphaja Pandu.

• As there were less subjects of Vataja and Pittaja Pandu in the study, their findings in

the morphological changes in RBC in peripheral blood smear are insufficient in

drawing out a proper conclusion.

• Even though in classics Vata piita and Vata kapha Pandu roga is not mentioned

separately but in this study it was found in few subjects. So we can consider these

types on the basis of presentation of Lakshanas.




SUMMARY

The loss in the normal color or discoloration of the body is called as Panduta. Along

with loss of normal color or discoloration of the skin, loss or abnormalities are seen in

the texture and luster of skin. This is more specifically observed in nails and conjunctiva.

The Pratyatma lakshana of Pandu is described as similar to the color of ketaki dhuli.

Hence a diagnostic Study entitled –“A STUDY ON THE DIAGNOSTIC VALUE OF

BLOOD PERIPHERAL SMEAR IN DOSHAJA PANDU ROGA” was undertaken for

the study to know the abnormal morphology of RBC’s in the varients of Pandu roga.

This present study was conducted on the disease Pandu roga. Hence in the first

part of dissertation detailed review of literature regarding the nirukti, paribhasha,

paryaya, bheda, nidana panchaka, sadhyasadhyata and Upadrava of Pandu roga. Along

with this detail about erythropoiesis, peripheral blood smear, staining procedure has been

mentioned.

Second part of dissertation contains the materials and methods used in the present

study, observation and results of the study, discussion on observations and results. This

part also includes conclusion of the study.

Study was completed in 50 patients having the Pratyatma lakshana along with the

Vishishta lakshana of Pandu roga. Informed consent was taken from the subjects and

peripheral blood smear was done and abnormal morphology was observed using 100X oil

immersion microscope.




The observations were done on the factors like Nidanas, Lakshanas and the

findings of peripheral blood smear were related to the types of Pandu roga.




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JSS AYURVEDA MECICAL COLLEGE AND HOSPITAL, MYSURU

DEPT OF POST GRADUATE STUDIES IN ROGA NIDANA

Dissertation Title : A Study on the diagnostic value of Peripheral Blood smear

in different types of doshaja Pandu roga.

Subject No : _____________

CONSENT FORM

I ___________________________________ am exercising my free will, to participate in above

study as a subject. I confirm that the study has been explained to me adequately understood the

above study & had the opportunity to ask questions. The information given by me will be used

for Medical Research only & I will not be identified in any way in the analysis & reporting of the

Results. I hope to complete the study, but I understood that my participation is voluntary & I am

free to withdraw at any time, without giving a reason & without any medical care or legal rights

being affected. The data collected will have right of authority for the researcher for further utility

and for publications.

Queries Related to Study :

If you have any queries related to study please call the researcher

Mobile no :




Place :

Date : Signature of Subject

Signature of Researcher Signature of Guide

( Dr Shivani kaundal) ( Dr Venkatesha. S)

Signature of HOD




DEPT OF POST GRADUATE STUDIES IN ROGA NIDANA

JSS AYURVEDA MEDICAL COLLEGE AND HOSPITAL, MYSURU.

Dissertation Title:

“A STUDY ON THE DIAGNOSTIC VALUE OF BLOOD PERIPHERAL SMEAR

IN DIFFERENT TYPES OF DOSHAJA PANDU ROGA”

ANNEXURE 1- SCREENING

1. Code no. :

2. Name of the subject :

3. Gender: male (2) female (1)

4. Date of birth

5. Age (in years)

6. Address: present- postal address with phone number and email id if any:

___________________________________________________________________

SAMANYA LAKSHANA

Sl.NO LAKSHANA PRESENT

1 Twak vaivarnayata (pale color)

2 Anna dwesha (aversion to food)

3 Alpa vak (diminished speech)

4 Hatanala (loss of digestion)

5 Nidralu (oversleep)




6 Shuna akshi koota (peri orbit swellings)

7 Anga sada (malaise)

8 Sthivana (spitting)

9 Kopana (irritability)

10 Shishira dweshi (aversion to cold)

11 Sheerna loma (falling of skin hair)

12 Jwara (fever)

13 Shwasa (dyspnoea)

14 Karna kshwedi(tinnitus)

15 Bhrama (giddiness)

16 Shrama (exhaustion)

17 Hataprabha (loss of lustre)

18 Durbala (debility)

19 Pindikodwestana (pain in shank)

20 Kati,uru,padaruk(pain in waist, thigh, legs)

21 Sadana (lassitude)

22 Arohana ayasa(exertion)

NO. OF SAMANYA LAKSHANA PRESENT:




ANNEXURE - 2

CASE PROFORMA

Case. No. : O. P. No.:

1. Name : I. P. No:

2. Age (in years) : 3.Sex :

4. Religion: A. Hindu ( ) B. Muslim ( )

C.Christian ( ) D. Other (Specify)

5. Occupation :

6. Marital status : A. Married B. Unmarried C. Widow D.Divorced

7. Educational Status: A. Illiterate B. Primary C. High School D. PUC/ Diploma

E. Graduate F. Post Graduate

8. Socio-Economic Status (B G Prasad classification) I / II / III/ IV / V

8.1 Total members in family :

8.2 Total monthly income in Rs :

9. Locality : A. Urban ( ) B. Rural ( )

Postal Address and Phone No:

Diagnosis:




PART – A

HISTORY AND EXAMINATION

10. PradhanaVedana/Chief complaints :

Vaivarnayta: Krishna (blackish) ( ) Duration:

Aruna (reddish) ( )

Shweta (pale) ( )

11. AnubandhaVedana/Associated complaint:

12. PradhanaVedanaVrittanta/H/O Present illness:




13. PoorvaVyadhiVrittanta/Past history:

14. Chikitsa Vruttanta/ Treatment history :

14.1. For present complaint: A. Taken ( ) B. Not taken ( )

14.2. For any other diseases: A. Taken ( ) B. Taking ( ) C. Not taken ( )

14.3. Treatment Course : A. Completed ( ) B. Discontinued ( )

Sl. no History Category Present Absent Duration

1 MEDICAL HISTORY 1.Hypertension

2.Diabetes mellitus

3.Hyper/hypo thyroidism

4. Recent blood donation

5.Infectious diseases

6. other

2 SURGICAL HISTORY

3 CHILDHOOD HISTORY 1.Vaccination

2.Other




14.4. Details of Drugs taken & Taking :

Morbidity Name Dose Duration

DM

HTN

Other

15. Kula Vrittanta/Family history:

Sl. no H/O Diseases Mother (A) Sister (B) Father (C) Brother (D) Other (E)

1 Living Status

2 DM

3 HTN

4 Obesity

5 Anemia

7 Other




16. VayaktikaVrittanta/ Personal history :

16.1 Ahara : A. Vegetarian ( ) B. Mixed diet( )

16.2 Appetite : A. Increased ( ) B. Reduced ( ) C. Not altered ( )

16.3 Nidra :

Sl. No Duration (hrs)(a) Nature of sleep Cause for disturbance (d)

Sound (b) Disturbed (c)

A Ratri /Night

B Diva/Day sleep

16.4 Mala (Bowel) and 16.5 Mutra (Micturation)

Sl. No Bowel (4) Micturation (5) Duration

A Frequency a) Increased ( )

b) Not altered ( )

c) Reduced ( )

a) Increased ( )

b) Not altered ( )

c) Reduced ( )

B Urgency a) Under control ( )

b) Not under control ( )

a) Under control ( )

b) Not under control ( )

C Colour a) Normal ( )

b) Altered ( )

a) Normal ( )

b) Altered ( )

D Consistency a) Hard ( )

b) Soft ( )

a) Transparent ( )

b) Turbid ( )




16.6 Vyasana:

Sl. No Vyasana Status Details

Present (A) Absent (B)

1 Tea

2 Coffee

3 Alcohol

4 Smoking

5 Other

17. VyavasayaVrittanta/ Occupational History :

17.1. Type of Employment : Sedentary (A) Moderate (B) Heavy (C)

17.2. Nature of Work : Physical (A) Mental(B)

17.3. Time of Work : Day (A) Night (B) Day & Night (C)

17.4. Duration of Work : _____________hrs/day ___________ hrs/night

c) Loose ( ) c) Thick ( )

E Odour a) Altered ( )

b) Not alterd ( )

a) Altered ( )

b) Not alterd ( )

F Other




18. Artava, Garbini and SutikaVrittanta :

18.1. Age at menarche :

18.2. MC : A. Nature of cycles : Regular (a) / Irregular (b)

B. Time gap between the cycles :

18.3. MF : A. Duration of flow :

B. Quantity : Heavy (a) / Scanty (b) / Moderate (c)

C. Clots : Present ( ) / Absent ( )

D. Odour : Present ( ) / Absent ( )

18.4. White discharge : Present ( ) / Absent ( )

18.5. Itching in vulva : Present ( ) / Absent ( )

18.6.Obstetric History: A. Gravida ( ) B. Para( ) C. Abortion( ) D. Dead( ) E. Living( )

Rogi Pareeksha

19. SamanyaPareeksha/ General examination :

1. Consciousness : A. Present ( ) B. Absent ( )

2. Built/ Akriti : A. Poorly built ( ) B. Well built ( ) C.Over built ( )

3. Nourishment / : A. Malnourished B. Well nourished C. Over nourished

Upachaya

4. Pallor : A. Present ( ) B. Absent ( )

5. Icterus : A. Present ( ) B. Absent ( )

6. Cyanosis : A. Present ( ) B. Absent ( )

7. Clubbing : A. Present ( ) B. Absent ( )




8. Edema : A. Present ( ) B. Absent ( )

9. Lymph adenopathy : A. Present ( ) B. Absent ( )

10. Height : ______ cms. (_________ft)

11. Weight : _______ kgs

12. BP / Raktachapa : ________ mm of Hg

13. Pulse : ______ / min

14. Respiratory rate : ______ /min

15. Temperature : ____0 F

20. SYSTEMIC EXAMINATION

1. Cardio vascular system

2. Respiratory system

3. Digestive system




4. Musculoskeletal system

5. Nervous system:

21. ASHTA STHANA PAREEKSHA

Sl. no Astasthana Pareeksha lakshanas Present

1 Nadi A. Teekshna

B. Madhyama

C. Manda




2 Mutra A. Pandu

B. Rakta

C. Phenayukta

3 Mala A. Ruksha

B. Peeta

C. Shweta

4 Jihwa A. Cold, rough and cracked (brown or black)

B. Reddish and blackish

C. Whitish and sticky

D. Blackish, Kantaka (thorny) and dry

5 Shabda A. Hoarse and rough

B. Sphuta vaktra (cracked)

C. Guru (heavy)

6 Sparsha A. Cold and rough

B. Hot and moist

C. Wet and cold

7 Druk A. Sunken, dry and reddish brown

B. red or yellow

C. wet & watery

8 Akruti A. Krusha

B. Madhyama

C. Sthoola




21. Dashavidhapareeksha

Sl.

No

Dashavidha

pareeksha

Gross idea Specific findings Present

1 Prakruthi A.Eka a) Vata

b) Pitta

c) Kapha

B.Dwandwa d) Vatapitta

e) Vatakapha

f) Pittakapha

C.Tridoshaja g) Vatapittakapha

2 Vikruthi A.Hetu

a) Shaareerika

b) Manasika

B.Dosha c) Vata

d) Pitta

e) Kapha

C.Dushya f) Rasa

g) Rakta

h) Mamsa

i) Asthi

j) Majja

k) Shukra

D.Prakruti a) Yeka




b) Dwandwa

c) Tridosha

E.Desha (srotus) a) Prana

b) Udaka

c) Anna

d) Rasa

e) Rakta

f) Mamsa

g) Asthi

h) Majja

i) Shukra

j) Mutra

k) Pureesha

l) Sweda

m) Arthava

n) Manovaha

F.Kala a) Chaya

b) Prakopa

c) Prasara

d) Sthanasamraya

e) Vyakta

f) Bheda




G.Bala a) Pravara

b) Madhyama

c) Avara

3 Sara A. Twak Sara:

Snigdha(Unctous), Slakshana(Smooth),

Mrudu(Soft Skin &Hair), Sukshama (Fine Hair),

Gambhira(Deep Rooted Hair), Sukumara

Loma(Tender Hair), Prabha(Lusturous Skin)

B. Rakta Sara

Red Colored Eyes, Hair, Ears, Face, Tongue,

Nose, Lips, Soles Of Hand And Feet, Nails,

Forehead.

C. Mamsa Sara:

Shankha ,Lalata ,Krikatika, Akshi, Ganda ,Hanu,

Griva, Pani , Pada, Sandhi( Heavy, Compact,

Beautiful, Handsome)

D. Meda Sara

Unctous In Varna, Swara, Netra, Kesha, Loma,

Nakha, Danta, Oshta, Mutra, Puresha.

E. Asthi Sara: Parshini(Heels), Gulfa(Ankle),Janu(Knees),

Trik(Forearms), Chibuka(Chin), Shira(Head),

Parva Shtoola(Joints), Sthoola Asthi, Nakha,

Danta

F. Majja Sara: Mridu Anga(Softness Of Organs), Balavanta(

Strength0, Snigdha Varna(Unctous Complexion &

Voice), Sthoola Dhrigha Vrut And Sandhi( Big,

Wide Joints)

G. Shukra Sara: Soumya(Gentle), Snigdha(Unctous),




Vritsara(Round),Mahasphik(Large Buttocks),

3A In total sara of person a) Pravara (>4)

b) Madhyama (3-5)

c) Avara (<3)

4 Samhanana A. Symmetry &

demarcation of

bones

a) Strong

b) Moderate

c) Weak

B. Development of

joints

a) Strong

b) Moderate

c) Weak

C. Compactness of

muscles

a) Strong

b) Moderate

c) Weak

D. Built a) Strong

b) Moderate

c) Weak

d) Strength a) Strong

b) Moderate

c) Weak

4A In total samhanana of person a) Pravara (>3)




b) Madhyama (2-3)

c) Avara (<2)

5. Pramana a) Pravara

b) Madhyama

c) Avara

6 Satva a) Pravara

b) Madhyama

c) Avara

7 Satmya A. Dravya satmya a) Gritha

b) Ksheera

c) Taila

d) Mamsa rasa

B. Rasa satmya a) Madhura

b) Amla

c) Lavana

d) Katu

e) Tikta

f) Kashaya

C. Veerya satmya a) Ushna

b) Sheeta

D. Guna satmya a) Shuksha

b) Drava




c) Snigdha

d) Rooksha

E. Other Others

8

Ahara shakti

A. Abhyavarana

shakti

a) Pravara

b) Madhyama

c) Avara

B. Jarana shakti a) Pravara

b) Madhyama

c) Avara

9

Vyayama

shakti

Karmashakti a) Pravara

b) Madhyama

c) Avara

10 Vaya A. Bala a) Kumara

b) Youvana

B. Madhyama a) Madhyama

C. Vrudhdha b) Vrudhdha




ANNEXURE-3

NIDANAS

AHARA JANYA NIDANA’S :

Sl No. Nidana No(0) Yes(1)

1 KSHARA

2 LAVANA

3 KATU

4 KASHAYA

5 ATI TIKSHNA

6 ATI USHNA

7 VIRUDDHA

8 VIDAGDHA

9 ASATMAYA

10 NISHAPAVA

11 MASHA

12 TILA TAILA

13 MADHYA

14 AMLA

15 MRITTIKA




BHAKSHANA

VIHARA JANYA NIDANA’S:

Sl

No.

Nidana No(0) Yes(1) Duration

1 DIVASWAPNA

2 VYAYAMA

3 MAITHUNA

4 PANCHAKARMA

VAISHMYA

5 RUTU VAISHMYA

6 NIDRA NASHA

7 SHRAMA

8 VEGA VIDHARANA

MANASIKA NIDANA’S:

Sl No. Nidana No(0) Yes (1)

1 BHAYA

2 CHINTA

3 KRODHA

4 MANASTAPA




5 SHOKA

VISHISHTA LAKSHANA:

(1) VATAJA PANDU:

Sl.NO LAKSHANA PRESENT(1) ABSENT(0)

1 ANGAMARDA

2 TODA

3 KAMPA

4 KRISHNA, RUKSHA, ARUNA SIRA

5 NAKHA VIN MUTRA NETRA

6 SHOPHA

7 ANAAHA

8 AASYA VAIRASYA

9 VARCHA SOSHA

10 PARSHVA SHOOLA

11 SHIRO RUJA

12 BALAKSHAYA

13 RUJA

14 BHRAMA




NO. OF VATAJA PANDU LAKSHANA PRESENT:

(2) PITTAJA PANDU LAKSHANA:

SL.NO LAKSHANA PRESENT(1) ABSENT(0)

1 PEETA/ HARITA VARNA

2 JWARA

3 DAHA

4 TRISHNA

5 MURCHHA

6 PEETA MUTRA, VIN, NAKHA

7 PEETA SIRA

8 SWEDA

9 SHEETA ICCHA

10 DOURGANDHYA

11 KATU ASYA

12 VARCHA BHEDA

13 AMLA UDGARA

14 VIDAHA

15 VIDAGDHA ANNA

16 DOURBALYA




17 TAMA

NO.OF PITTAJA LAKSHANA PRESENT:

(3) KAPHAJA PANDU:


1 GOURAVA

2 TANDRA

3 CHARDI

4 SHVETAABHASA

5 PRASEKA

6 LOMAHARSHA

7 SADA

8 MURCHHA

9 BHRAMA

10 KLAMA

11 SHWASA

12 KASA

13 AALASYA

14 ARUCHI

15 VAK SWARA GRAHA

16 SHUKLA MUTRA AKSHI VARCHAS

17 KATU RUKSHA USHNA KAMTA

18 SHVAYTHU




19 MADHURA ASYA

20 SWARA KSHAYA

NO. OF KAPHAJA PANDU LAKSHANA PRESENT:

(4) SANNIPATAJA PANDU:


1 TANDRA

2 AALASYA

3 SHWAYATHU

4 VAMATHU

5 KASA

5 HRILLASA

6 SHOSHA

7 NETRA PARUSHA

8 JWARA

9 KSHUDHA

10 MOHA

11 TRISHNA

12 KLAMA

NO. OF SANNIPATAJA LAKSHANA PRESENT:

TYPE OF PANDU ROGA PRESENT:




VATAJA (1)___ PITTAJA(2)___ KAPHAJA(3)___ SANNIPATAJA(4)___

VATA PITTA (5)__VATA KAPHA (6)___

FINDINGS OF BLOOD PERIFERAL SMEAR:

SIZE OF RBC’S: GRADING: 0- Absent, 1- Few (10-50 cells), 2- Moderate (51-100 cells),

3- Many (>100cells)

Normocytic

Microcytosis

Macrocytosis

Anisocytosis

CROMASIA: Normochromic

Hypochromic

Absence of central pallor

SHAPEOF RBC’S: GRADING: 1-Few (1-2 cells), 2-Moderate (3-5 cells), 3-Many (>5 cells)

Poikilocytes

Sickle shape

Spherocytes

Ovalocytes

Burr cells




Target cells

Spur cells

Roulex formation

Schistocytes

Dacrocytes

Signature of Researcher Signature of Guide

Dr SHIVANI KAUNDAL Dr. VENKATESHA .S

Signature of HOD

Dr VENKATESHA. S




DEPT OF ROGA NIDANA

JSS AYURVEDA MEDICAL COLLEGE, MYSURU

PRAKRITI ASSESSMENT

1. Name of the Subject: ___________________________________________

Assessment

of Prakriti:

S.No.

FEATURES VATA (V) PITTA

(P)

KAPHA(K) V P K

1 Body Structure Short, thin,

weak

Medium,

fleshy,

plump

Well built,

complete,

strong

2 Body Weight Low, hard to

gain,

easy to loose

Moderate,

good

muscles

Heavy, obese,

easy to gain

3 Joints Protruding,

creaking,

unsteady

Loose,

moderately

hidden

Strong, well

knit, compact,

well hidden




4 Movements Unsteady,

habit of

waving arms

& Legs

Fast Slow, steady

5 Shoulders Thin, small Medium Broad, strong

6 Chest Narrow Normal Deep

7 Arms Short Medium Long

8 Hands Small, dry,

cold,

rough

Medium,

warm,

pink

Large, thick,

moist, cool

9 Legs Small, hard Medium,

small

Round, firm

10 Feet Dry, rough,

cracks

Medium,

soft, pink

Large, soft

11 Nose Thin, small,

crooked

Medium Wide

12 Eyes Large or small,

darting around

unsteadily

Average,

thin,

reddened

easily,

piercing

Wide, white,

moist, steady

13 White of the

eye

Dirty Yellowish Milky white




14 Nails Thin, hard,

brittle

Soft, pink,

rubbery

Strong,

smooth, pale,

thick

15 Lips Dry, cracked Thin Thick

16 Neck Long, thin Medium Thick

17 Teeth Irregular in

size,

crooked,

pigmented

Medium,

even with

cavities

Even, large,

white

18 Gums Receding,

brown

Bleeding,

red

Pink, good

19 Tongue Coated with

grayish

pink film

Coated

with

yellowish

green film

Coated with

white film

20 Forehead Small Medium

with lines

Large

21 Head Small Medium Large

22 Strength Low, gets tired

fast

Moderate Good

23 Appetite and

digestion

Variable,

needs frequent

meals

Strong,

enjoys

food,

Constant,

emotional

eaters




irritable if

meals are

missed

24 Bowel

movements

Dry, hard,

constipated

Soft, oily,

loose

Heavy, slow,

thick

25 Urine Scanty,

colorless,

often difficult

Profuse,

yellow or

red, often

burning

Moderate.

white or

milky

26 Body

temperature

Low, cold

palms and feet

Above

normal,

hot

palms,

feet, face,

forehead

Normal, palms

and

feet are

slightly cold

27 Physical

activity

Quick, erratic,

restless

Motivated,

purposeful,

goal

oriented

Slow, steady,

methodical

28 Voice Low, weak,

hoarse, cracks

Medium,

clear

Deep, pleasant

29 Speech Quick,

talkative

Argumenta

tive, likes

Slow,

deliberate




debate,

convincing

30 Immunity Variable, low Moderate,

subject to

infections

Strong

31 Sleep pattern Light, tends

towards

insomnia

Moderate

but sound

Heavy,

difficult to

wake up,

sleeps easily

32 Quality of pulse Faint,

wavering

Moderate,

jumping

Slow and

graceful

33 Pulse rate 80 - 100 beats

per minute

70 - 80

beats per

minute

60 - 70 beats

per

minute

34 Speed of work Fast, in a hurry Medium,

fast

Steady, slow

35 Sweating Little, odorless Profuse,

strong

smell

Moderate,

pleasant

smell

36 Complexion Dull, brown,

tans

without

Flushed,

pigmented,

fair,

White, pale,

tans

evenly with




sunburn sunburns

easily

little

sunburn

37 Skin condition Dry, rough,

cracked with

freckles and/or

acne

Warm,

moist, pink

White, moist,

cool,

soft

38 Hair texture Coarse, dry,

wavy

Fine, light

colours,

early

greying or

balding

Abundant,

oily,

lustrous

39 Hair color Dark brown to

black

Light

blonde,

red, light

brown

Medium

blonde,

medium to

dark

brown

40 Scalp hair Thin, curly,

short

Light,

straight

Thick, black,

long

41 Eye lashes Inconspicuous Medium Thick, dark

42 Eye brows Thin, small Medium Thick, dark

43 Body hair Sparse Sparse, on

the chest

Hairy

44 Consumption of Not fixed Comparati Comparatively




food and drinks vely more less

45 Snacks Likes crunchy

snacks

Likes cold

drinks and

snacks

Sweets and

creamy

snacks

46 Food

preferences

Hot and Wet Cold and

warm

Hot and dry

47 Climate

preferences

Likes sunny

weather

Likes cool

weather

Likes warmth,

suffers in the

cold

48 Habits Likes

travelling, fun,

entertainment

Likes

physical

sports,

politics,

activities

Water sports,

gardening,

business

49 Grasping

power

Sometimes

grasps

quickly

Quick to

grasp, very

sharp

Grasps late but

understands

best

50 Emotional state Anxious,

nervous,

creative

Angry,

irritable,

jealous

Attached,

sentimental,

depressed

51 Memory Quick but poor

in the long

term

Clear Slow, good in

the

long term




52 Finance

management

Spends freely Tends to

budget

Saves, spends

emotionally

53 When

threatened

Fearful.

anxious

Angry,

irritable,

fights

Indifferent,

withdraws

54 Tackling

problems

Worrying

constantly,

cannot take

one stable

decision

Takes firm

decision

quickly

Can take the

right

and firm

decision

but takes time

55 Cannot tolerate Cold Heat,

anger,

physical or

mental

exertion,

hunger,

thirst,

physical

urges

Can tolerate

cold,

heat, anger,

exertion,

physical

urges, hunger

or

thirst

56 Nature of

dreams

Flying,

Moving,

Strong Winds,

Nightmares

Colorful ,

passionate,

fire,

lightning,

Romantic,

uneventful,

few

dreams, water,




conflicts gardens,

faintly

colored

57 Thought

process

Questions,

theorizes

Judgmenta

l, artistic

Stable, logical

TOTAL NO. OF FEATURES V = P= K=

Vata-Pittaja (1) Vata-Kaphaja (2) Pitta-Kaphaja (3)




Fig 1: showing Erythropoesis

Fig 2: showing RBC structure




Fig. 3: Different steps in the preparation of peripheral blood smear

And appearance of well made smear

Fig 4: showing a well made smear having Head, body and tail

Fig 5: Showing microcytic hypochromic picture of RBC




Fig 6: Showing Anisocytic hypochromic picture of RBC.

Fig 7: Showing target cells

Fig 8: Showing Burr cells




ARTICLE PUBLISHED IN ANVESHANA AYURVEDA MEDICAL

JOURNAL VOL3, ISSUE 4.

PANDU ROGA: SAMANYA SAMPRAPTI AND IT’S AMSHAMSHA

KALPANA

Shivani kaundal* Venkatesha.S**

*P.G Scholar, Dept of PG studies in Roga nidana, JSS Ayurveda Medical College and Hospital,

Mysuru, Karnataka.

**Reader and HOD, Dept of PG studies in Roga nidana, JSS Ayurveda Medical College and

Hospital, Mysuru, Karnataka.

ABSTRACT

Pandu roga has been regarded as a Pitta pradhana vyadhi in which along with other

features there is Pandu vaivarnayata i.e development of whitish yellow discoloration all over the

body. The Pratyatma lakshana of Pandu is described as similar to the color of ketaki dhuli. It

exhibits symptoms like Panduta, Dourbalyata, Arohana ayasa, Bhrama etc. Most important

factor in the pathogenesis of Pandu roga is Mandagni. This paper is an attempt to understand the

Nidana, Samanya samprati with Amshamsha kalpana along with and Samanya lakshana of

Pandu roga with its vitiated Dosha associated with Vridhi and Kshaya of its Guna.

KEYWORDS: Pandu roga, Samanya samprapti, Vikalp samprapti, Amshamsha kalpana.

INTRODUCTION:

The loss in the normal color or discoloration of the body is called as Panduta. Along with loss of

normal color or discoloration of the skin, loss or abnormalities are seen in the texture and luster

of skin. Pandu roga has been regarded as a Pitta pradhana vyadhi1 in which along with other

features there is Pandu vaivarnayata i.e development of whitish yellow discoloration all over the




body. This is more specifically observed in nails and conjunctiva. The Pratyatma lakshana2 of

Pandu is described as similar to the color of ketaki dhuli.

“Rogaaha sarvepi mande agnow”- as said by Vagbhata, Mandagni is also the major factor in the

pathogenesis of Pandu. The resultant effect of Mandagni is Rasadushti and Rasa is the

Pradhana dhatu involved in Pandu roga. So, Acharya Charaka as well as Sushruta have

included Pandu roga in Rasa pradoshaja vyadhi.3,4

Pareeksha is an integral part of clinical medicine. Pareeksha, as said in classics includes both

roga as well as Rogi pareeksha. The latter one is utilized in examining a patient whereas the

former one is used in understanding a disease. Roga pareeksha includes Nidana panchaka.

Samprapti is the key factor to understand the disease in detail and along with other component of

nidana panchaka, it aids in planning proper treatment.

Vikalpa samprapti is a type of Samprapti that deals regarding Amshamsha kalpana which

literally means “knowing in-depth”. It helps in understanding the disease by means of dissecting

it i.e the Dosha that is responsible for the production of the disease is understood not as a Dosha

as a whole but by determining the Vikriti in its guna and karma. Agni is given high credentials in

Ayurveda and Agni vikriti in terms of Mandagni is a major contributing factor in production of

many diseases and one such disease is Pandu roga.

AIM:

To study the Samanya samprapti of Pandu roga, mentioned in Ayurvedic samhitas and to

understand the Vikalpa samprapti and Amshamsha kalpana in detail.

STUDY MATERIAL:

Pandu roga is studied with different lexicon present in central library, all the Brihataryee and

Laghutrayee, various journals and internet source.

NIDANA5,6:

AAHAARAJA NIDANA:




• Kshara, Amla, Katu, Lavana dravyas aggravate Pitta.

• The regular intake of Amla rasa vitiates Pitta and Kapha dosha.

• Viruddha ahara leads to vitiation of “Tridoshas”.

• Tila is Pittakara & Ushna veerya and in turn increases Pitta.

• Diwaswapna vitiates tridosha and depresses the function of Jataraagni and Dhaatwagni.

• Ati Teekshna Ahara causes Daaha as it is of Agni bhoota predominance.

• Madya does Pitta vitiation.

VIHAARAJA NIDANA:

• Diwaswapna , Ratri jagarana , Ati vyayama, Ati vyavaya, Adhika Shrama ,Vegadharana,

Rutu vaishamya. Among these, Diwaswapna causes Pandu by vitiation of Tridosha and

Ratrijagarana by Vata prakopa and Ati vyavaya causes Tridosha prakopa.

MANASIKA NIDANA:

The Manasika nidanas also plays a major role in the causation of Pandu such as Kama,

Krodha ,Bhaya ,Chinta ,Shoka. Where Kama, Shoka and Bhaya vitiate Vata dosha ,

krodha vitiates Pitta dosha, and Chinta vitiates Vata & Kapha and produce Vataja, Pittaja

and Kaphaja predominant Panduroga.

PRATIKARMA VAISHAMYA:

Pandu roga can also be caused due to improper usage of especially Snehatiyoga,

Amatisara samgraha, Dushta rakta nigraha in raktarsha, Vega vidharana in Vamana

karma.

NIDANAARTHAKA ROGA:




Pandu is a disease itself and occurs as a symptom also in many of the diseases. Some of

them are as follows:

Raktarsha7, Krimi8, Punaraavartaka jwara9, Pleehodara10, Sira vyadhana11, Raktapitta12,

Raktarbuda13 which directly or indirectly vitiate Vata, Pitta and Kapha singly or in

combination.

POORVAROOPA.14,15,16

CHARAKA

(Ch. chi. 16)

SUSHRUTA

(Su. ut. 44)

VAGBHATA

(Ah.ni 13)

Hridaya

spandanadhikya

Twaksphotana

Hridaya spandana

Roukshyam

Steevana

Mootra peetata

Swedoabhava

Gaatra saada

Rookshata

Shrama

Mrid Bhakshaneccha Alpa vanhita

Prekshana koota

shotha

Swedoabhava

Avipaka

Aruchi

Vitpeetata

SAMPRAPTI17:

NIDANA SEVANA




PIITA PRADHANA TRIDOSHA PRAKOPA

AGNI VIKRITI

HRUDAYA KHA VAIGUNYA

RASA DUSHTI

PIITA + DUSHITA RASA

Circulates through DASHA DHAMANIS VYAN VAYU

ASHRAY in TWAK & MAMSA

Vitiates RAKTA, KAPHA, VATA, TWAK, MAMSA etc

Produces HARITA, HARIDRA, PANDU varna.

PANDU ROGA

Though Tridosha are vitiated in Pandu roga, Pitta plays dominating role in its

Samprapti. Nidanas (aaharaja as well as vihaaraja, mainly pitta prakopakara) does pitta dosha

vikriti. Since Pachaka pitta is situated in the grahani,the vitiated Pitta affects the Agni. The

Dravata in this Vidhagdha pitta reduces its Teekshnata. Hence this agni cannot digest the

aahaara which is consumed , thereby leading to Vidagdha bhava of Annarasa.

This Annarasa is taken by Vyan vayu to Hrudaya and transforms it into Rasa datu. The Vihaara

like Ativyayama, ativyavya etc causes vitiation of Vyan vayu. This vitiated Vyan vayu along with

Pitta and Dushita Rasa dhatu circulates throughout the body through the Dasha dhamani that

emerges from the Hrudaya.

Finally, Rasa dhatu lodges in Twak and Mamsa, then by vitiating the kapha, Vata, Rakta, Twak

and Mamsa it produces Pandu, Haridra, Harita varna. And out of these Pandu varna is seen

predominantly.




VIKALP SAMPRAPTI18 & AMSHAMSHA KALPANA19:

Vikalpa samprapti is a type of Samprapti deals regarding Amshamsha kalpana which

literally means “knowing something part by part”. It helps in understanding the disease by means

of dissecting it i.e the Dosha which is responsible for the production of the disease is understood

not as a Dosha as a whole but by determining the Vikriti in its guna and karma. To point out a

lakshana or a vyadhi which is arising from a particular disease causing dosha is assessed by

Vikalp samprapti. In the classification of samprapti there is mentioning of Vikalp samprapti.

Where there will be some involvement of every dosha.

List of Samanya lakshana20 and their Dosha and Guna prakopa21:

1. KARNAKSHWEDA Vata vriddhi Chala guna

2. HRUDYA SPANDANA Vyana vata, sadhaka pitta Chala ,sara guna

3. DOURBALYA Vata vriddhi Sukshma, chala guna

4. ANGASADA Vata vriddhi Sukshma guna

5. SHRAMA Vata vriddhi Sukshma guna

6. BHRAMA Vata ,pitta vridhi ,kapha

kshya

Chala, sara ,sthira guna

7. GATRASHOOLA vata vriddhi Sheeta guna

8. SHWASA Vata kshaya Chala, sukshma guna

9. GOURAVA Kapha vridhi Guru guna

10. ARUCHI Kapha vridhi Guru guna

11. SHOONA AKSHI KOOTA Kapha vridhi Guru guna

12. HATAPRABHA Pitta kshaya Ushna, Drava guna

13. KRODHA Pitta vridhi Ushna ,teekshna

14. SHISHIRA DWESHI Vata- kapha vridhi Sheeta guna

15. NIDRALU Kapha vridhi Guru guna

16. HARIDRA, HARITA VARNA Piita vridhi Drava guna

17. ALPA VAKTVUM Vata kshaya Shukshma guna

18. AAROHANA AYASA Vata kshaya Laghu, sukshma guna




19. SHTHIVANA Kapha vridhi ,ama Guru, sheeta ,pichilla guna

20. PINDIKODWESHTANA Vata kshaya Sukshma guna

21. JWARA Pitta vridhi Ushna guna

22. HRIDRAVA Vata –pitta vridhi Sara, chala guna

CONCLUSION:

1 Pandu roga is one of the prevalent disease in Indian subcontinent

2 It is a Rasadusti janya vyadhi.

2. It is a disease predominantly characterized by pathological variation in skin color and named

after different discolorations of the body mainly Pandu varna.

3. Being a Pitta pradhana vyadhi, Agni plays a prime role in its Samprapti.

4. Although Pandu is a tridoshaja vyadhi, Pitta is a aarambhaka dosha for the manifestation of

disease.

5. When we look at the vyadhi, it is observed that mainly Rasavaha strotas gets affected in it,

leading to further vitiation of Raktavaha strotas. So it can be concluded that both the strotas gets

vitiate in Pandu roga.

6.By thorough examination of lakshana in a disease we can assess Gunatah, Karmatah,

Dravyatah Vriddhi or Kshaya of that particular Dosha and hence we can plan the treatment

accordingly.

BIBLIOGRAPHY:

1) Acharya YT, ed; Charaka samhita Ayurveda dipika commentary, Chaukhamba Oriental,

Varanasi 2007, p- 526.

2) Radhakantdev Raja, Shabdakalpadruma, vol 3, Nag publishers, Delhi 2002, p-104.


Varanasi 2007, p-179.

4) Acharya YT, Susruta Samhita Nibandhasangraha commentary, Choukambha Sanskrit

Sansthan 1997 Varanasi, p-116.




5) Acharya YT, ed; Charaka Samhita Ayurveda dipika commentary, Choukambha oriental,

Varanasi ,2007 P- 526.


Sansthan 1997 Varanasi, p- 730.

7) Acharya YT, ed; Charaka samhita Ayurveda dipika commentary, Chaukhamba

Oriental, `Varanasi 2007, p-503

8) Tripathi bramhanand, Madhavanidana, Madhukosha commentary, Choukhamba

Surbharati publication, Varanasi, p-307.


Varanasi 2007, p-427


Sansthan 1997, Varanasi, p-297.

11) kunte moreshwar anna, Ashtangahridayam, Hemadri teeka, choukhamba Sanskrit

samsthan, Varanasi, p-


Sansthan 1997, Varanasi, p-735


Sansthan 1997, Varanasi, p-

14) Acharya YT, ed; Charaka samhita Ayurveda dipika commentary, Chaukhamba

Oriental, Varanasi, 2007, p-527.


Sansthan 1997 Varanasi, p-

16) Kunte Moreshwar Anna, Ashtangahridayam, Hemadri teeka, Choukhamba Sanskrit

Samsthan, Varanasi, p-

17) Acharya YT, ed; Charaka samhita Ayurveda dipika commentary, Choukhamba

Oriental, Varanasi, 2007, p-527.

18) Murthy Himasagar Chandra, Madhav nidana, Madhukosha commentary, choukhamba

oriental, 2006, p-28.




19) Murthy Himasagar Chandra, Madhav nidana, Madhukosha commentary, choukhamba

oriental,2006, p-28.


Varanasi 2007, p-527.

21)Sharma sadashiv.k ,Samprapti lakshanayoho sambhandha, Ayurveda sanatakottara

shikshana Kendra, Jamnagar. p-69-72.

smear in different types of doshaja pandu roga

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