Ayurveda Treatment Methods

A Guide Line To Ayurveda Treatments & Principles

PANDU (ANEMIA) Treatment Protocol by Ayush

 

INTRODUCTION AND CASE DEFINITION:

Pandu is a disease classification involving mainly the Rasa Dhatu with Panduta (pallor) as the presenting cardinal symptom. Other associated symptoms are fatigue, malaise, fever, weight loss, night sweats, palpitation, dyspnoea on mild exertion. Various disease conditions affecting formation of hemoglobin falls under the umbrella of Pandu Roga.

 

Clinical signs and symptoms of Pandu (Anemia):

 

Pandu is a disease of Pittaja dominance with following presenting signs and symptoms

  1. Depleted functions of Dhatus in which Pitta is vitiated
  2. Kshaya of Varna, Bala, Sneha and other properties of Oja
  3. Raktalpata
  4. Alpa Meda
  5. Debility of relevant Karmendriya and Jnanendriya
  6. Discoloration

Classification of Pandu Roga:

5 types: Vataja, Pittaja, Kaphaja, Sannipataja, Mridbhakshanaja

 

Differential diagnosis of Pandu:

  1. Krimi Roga
  2. Kamala
  3. Jwara – Vishama Jwara
  4. Rajayakshma
  5. Grahani Roga
  6. Udara Roga
  7. Shotha – Kaphaja
  8. Arsha
  9. Asrigdara
  10. Shosha
  11. Raktapitta
  12. Other nutritional deficiencies - folic acid, Vit B12, Vit. C, protein, copper etc.

LEVEL 1: AT SOLO AYURVEDA PHYSICIAN CLINIC/PHC

Clinical Diagnosis: On the basis of history and clinical presentation, patient can be diagnosed provisionally as case of Pandu

Investigations: Though much can be diagnosed based on the clinical signs and symptoms, laboratory investigations help the clinician to confirm the diagnosis and rule out other conditions

  • Hemogram and peripheral blood smear
  • Urine – routine and microscopic examination
  • Stool – occult blood

Treatment:

Table 7.1: Medicines at level 1 for Pandu

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Amalaki Churna

Churna

3 gm

Every morning

2-3 months

Madhu/ warm water

Pippali Churna

Churna

1 gm

Twice daily

2-3 months

Madhu/ water

Chausastha Prahari Pippali

Churna

500 mg – 1gm

Twice daily

2-3 months

Madhu/ water

Guda Haritaki

Churna

3 gm

Every morning

2-3 months

Honey/ warm water

Chitrakadi Vati

Vati

500 mg

After meals

1 month

Warm water / butter milk

Drakshadi Kashaya1

Kwatha

20-40 ml

Before meal/ twice daily

2-3 weeks

-

Punarnavadi Kashaya2

Kwatha

20-40 ml

Before meal/twice daily

2-3 weeks

-

Phalatrikadi Kwatha

Kwatha

20-40 ml

Before meal/twice daily

2-3 weeks

-

Drakshavaleha3

Avaleha

5-10 gm

Before meal/ twice daily

2-3 weeks

-

Punarnava Mandoora4

Churna

250-500 mg

After meal / thrice daily

2-3 weeks

Madhu/ Takra

Dadimadya Ghrita

Ghee

5-10 ml

Before meal/ twice daily

2-3 weeks

Warm milk

 

Whenever needed symptomatic treatment of associated conditions can also been done e.g. if patients complains of loss of appetite, Chitrakadi Vati 1-2 tablet after meal twice or thrice daily can also be added.

Pathya-Apathya (Diet and life style):

Do’s–

  • Ahara: Purana Shali, Yava, Laja, Amraphala, Draksha, Dadima, Matulunga, Kadaliphala, Kharjura.
  • Vihara: Following of daily and seasonal regimen

Don’ts–

  • Ahara: Avoid excessive use of Kshara, Amla, Lavana, Katu, Kashaya, Atiushna, Tikshna, Rukshanna, Viruddha Asatmya Bhojana, Masha, Tila, Mridbhakshana and Dusta Jala
  • Vihara: Atinidra, Ativyayama, Atiayasa, psychological stress, Divaswapna, Ratri Jagarana and Vegavarodha

 

Referral criteria: Patient not responding to above mentioned management and showing advanced signs and symptoms of Pandu.

LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES

Clinical Diagnosis: Same as Level 1 for a fresh case reporting directly.

Investigation: Same as level 1. In addition

  • Test for sickling anaemia
  • Cytometric classification of Anemia ought to be done.

Treatment: In addition to the management mentioned in Level 1, few of the following drugs may be added as per the requirement and status of the patient.

Table 7.2: Medicines at level 2 for Pandu

 

Drugs

Dosage form

Dosage

Time of administration

Duration

Anupana

Dhatri Lauha5

Churna

250-500 mg

After meal/thrice daily

2-3 weeks

Buttermilk

Gomutra Haritaki6

Churna/

Vati

2-3 gm/1-2 tabs

Before meal/twice daily

2-3 weeks

Luke warm water

Navayasa Lauha7

Vati / Churna

250-500 mg

After meal/ thrice daily

2-3 weeks

Madhu

Vidangadi Lauha8

Churna

250-500 mg

After / thrice daily meal

2-3 weeks

Luke warm water

Swarnamakshika Bhasma

Bhasma

125-250 mg

Every morning

2-3 weeks

Madhu

Kasisa Bhasma

Bhasma

125-250 mg

Every morning

2-3 weeks

Madhu

Lohasava9

Asava

10-20 ml

After meal/twice daily

2-3 weeks

Equal quantity of water

Draksharishta10

Arishta

10-20 ml

After meal/twice daily

2-3 weeks

Equal quantity of water

Punarnavasava11

Asava

10-20 ml

After meal/twice daily

2-3 weeks

Equal quantity of water

Shilajitvadi Loha12

Vati

125-250 mg

Twice daily

2-3 months

Brahma Rasayana Avaleha13

 

 

As per the status of the patient, Mrudu Virechana/Koshtha Shuddhi with Avipattikara Churna 5-10 gm with Phalatrikadi Kashaya may be done for the first few days of the treatment.

Pathya-Apathya (Diet and life style): Same as Level 1

Referral criteria:

  1. Cases not responding to above therapy.
  2. Pandu cases with complications
  3. Severe Pandu cases

LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL LEVEL OR DISTRICT

HOSPITAL/ INTEGRATED AYURVEDIC HOSPITALS

Clinical Diagnosis: Same as Level 1for a fresh case reporting directly

Investigation: Same as level 1 and 2. In addition

  • Bone marrow cytology

Treatment: In addition to the management of Level 1 and Level 2, if needed Panchakarma procedures indicated for Pandu can be performed.

  • Shodhana Chikitsa:

Virechana: with Aragwadha Phala Majja/ Avipattikara Churna/ Sushka Draksha Kwatha

  • Rasayana Chikitsa:
  • Vardhamana Pippali Rasayana
  • Swarna Malini Vasant Rasa

Pathya-Apathya (Diet and life style): Same as level 1

REFERENCES

 

1 Vagbhatta, Ashtanga Hridaya, Atridev Gupt, Vidyotini Hindi commentary, Chaukhambha Prakashana, Edition Reprint 2008, Varanasi, Chikitsa Sthana Jwara Chikitsa 1/55,p. no. 395

2 Govind Das Sen, Bhaishajya Ratnavali, Siddhinandan Mishra, Siddhiprada commentary, Chaukhambha Surbharti Prakashan, Varanasi, Udara Rogadhikar 40/31-32, p. 733

3 Vagbhatta, Ashtanga Hridaya, Atridev Gupt, Vidyotini Hindi commentary, Chaukhambha Prakashana, Edition Reprint 2008, Varanasi, Chikitsa Sthana, Pandu Chikitsa 16/29-31, p. no. 541

4 Agnivesha, Charaka, Dridhabala, Charaka Samhita, Edited by Vaidya Yadavji Trikamji Acharya, Reprint Edition, Chaukhambha Surbharati Publication, 2011 Chikitsa Sthana Pandu Chikitsa Adhyaya 16/93-96, p.no. 530

5 Govind Das Sen, Bhaishajya Ratnavali, Siddhinandan Mishra, Siddhiprada commentary, Chaukhambha Surbharati Prakashan, Varanasi, Pandu Rogadhikar 12/30, p.378

6 Vagbhatta, Ashtanga Hridaya, Atridev Gupt, Vidyotini Hindi commentary, Chaukhambha Prakashana, Edition Reprint 2008, Varanasi, Chikitsa Sthana Pandu Chikitsa 16/29-31

7 Govind Das Sen, Bhaishajya Ratnavali, Siddhinandan Mishra, Siddhiprada commentary, Chaukhambha Surbharati Prakashan, Varanasi, Pandu Rogadhikar 12/28, p.378

8 Govind Das Sen, Bhaishajya Ratnavali, Siddhinandan Mishra, Siddhiprada commentary, Chaukhambha Surbharati Prakashan, Varanasi, Pandu Rogadhikar 12/31, p.378

9 Sharangdharacharya, Sharangadhara Samhita, Madhyama Khanda 10, Tra. Himsagar Chandra Murty, Varanasi, Chaukhambha Surabharati Series, 2007

10 Sharangdharacharya, Sharangadhara Samhita, Madhyama Khanda 10, Tra. Himsagar Chandra Murty, Varanasi, Chaukhambha Surabharati Series, 2007

11 Govind Das Sen, Bhaishajya Ratnavali, Siddhinandan Mishra, Siddhiprada commentary, Chaukhambha Surbharti Prakashan, Varanasi, Shotha Rogadhikar 42/111-115, p.786

12 Govind Das Sen, Bhaishajya Ratnavali, Siddhinandan Mishra, Siddhiprada commentary, Chaukhambha Surbharti Prakashan, Varanasi, Rajayakshma Rogadhikar 14/86,