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
- Depleted functions of Dhatus in which Pitta is vitiated
- Kshaya of Varna, Bala, Sneha and other properties of Oja
- Raktalpata
- Alpa Meda
- Debility of relevant Karmendriya and Jnanendriya
- Discoloration
Classification of Pandu Roga:
5 types: Vataja, Pittaja, Kaphaja, Sannipataja, Mridbhakshanaja
Differential diagnosis of Pandu:
- Krimi Roga
- Kamala
- Jwara – Vishama Jwara
- Rajayakshma
- Grahani Roga
- Udara Roga
- Shotha – Kaphaja
- Arsha
- Asrigdara
- Shosha
- Raktapitta
- 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:
- Cases not responding to above therapy.
- Pandu cases with complications
- 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,