Clinical study on Pandu roga w.s.r. to Iron deficiency anaemia and its management by Madhuyashti yog and Guda haritaki.

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Date of Acceptance : 01 Jun 2024

Date of Publication : 29 Jun 2024

Article ID : SD-IJAY_085

How to cite this article : http://doi.org/10.55552/SDNJAY.2024.2207

Abstract

Pandu roga, as the word describes itself that there is alteration of normal skin colour i.e. pale, yellowish discolouration of skin; thus it’s a Varnopalakshita Vyadhi. Pandu roga is described in Bhrita trayees and Laghu trayees both.

Acharya Charak considered Pandu is a disease of Rasavaha strotasa1 while according acharya sushrat pandu is a disease of Raktavaha strotasa2. Clinical manifestation of pandu roga are very much similar to that of iron deficiency anaemia. Tikshna shodhana, shaman chikitsa for panduroga are mention in ayurvedic text.

There is need to look for the ayurvedic treatment of Pandu roga which is coast effective and having less side effects. In this study 108 patients having symptoms of panduroga were selected and randomly divided into 2 groups. In group A, patients were trerated with Madhuyashti yog3 and in group B, patients were treated with Guda haritaki4. The data shows that statistically both groups are equally effective in managing the disease panduroga.

Key words- Pandoroga, Iron deficiency anaemia, Anaemia, Madhuyashti, Guda haritaki.

Introduction

Panduroga is pitta pradhan vyadhi5. Pitta get vitiated due to hetu sevana and in turn it vitiates rasa-rakata and other dhatus. Pitta and oja are responsible for normal body color and complexion. In panduroga pitta dosha and ultimately oja get vitiated which resulting into pale discolouration of skin. Daurbalya, Aruchi, Bhrama, Shithilaendriya, Raktalpata, Medalpata, Nissarta, Vaivarnya, Ojogunakshaya etc. are the Samanya Lakshanas of Pandu Roga6 given in Ayurvedic text which has very close resemblance with the description of iron deficiency anaemia available in modern texts in terms of causes, Aetiopathology, Sign-symptoms and Treatment. The commonest type of anaemia is Iron Deficiency Anaemia which is most prevalent nutritional deficiency disease in both the developed and developing countries with higher prevalence rate in children, adolescent girls and women of child bearing age. Anaemia is functionally defined as an insufficient red blood cells mass to adequately deliver oxygen to peripheral tissues.7 Iron Deficiency Anaemia is associated with Fatigue, Breathlessness, Palpitation, Dizziness, Headache, lrritability etc.8

Anaemia prevalence in India according to NFHS-5 (National family health survey) 2019 to 2021, it is found non-pregnant women aged 15-49 years who are anaemic (Hb less than 12gm/dl) is 57.2%, pregnant women aged 15-49 years who are anaemic (Hb less than 11gm/dl) is 52.2%, adolescent girls aged 15-19 years who are anaemic is 59.1%, men aged 15-49 years who are anaemic (Hb less than 13gm/dl) is 25% and adolescent boys aged 15-19 years who are anaemic is 59 (Hb less than 13gm/dl) is 31.1%9. Anaemia is a major global public health problem and the most prevalent nu-tritional deficiency disorder in the world. This article presents the Ayurvedic concept of Pandu Roga (Anaemia).

Discussion

In this study out of 108 patients, pandu were found in all age group. In young age due pittaadhikya, stress, in middle age due to stress, improper diet, in old age due to lack of nutrition, digestion problems and vatadhikya. According to sex 81 patients were female patients, which indicates that Pandu roga is more common in female because of lack of nutrition and menstrual bleeding. In Prakrutiwise distribution shows that Vata-Kapha predominance was found in 44 of patients, due to Vaya of patients and also intake of the Vata-kapha Vardhaka Nidana.

Overall Improvement in Subjective parameters and Objective parameters from Before Treatment to After Treatment 

Table no. 3

Graph no. 3

The comparative effect of treatment on parameters between trial and control was obtained as

For subjective parameters improvement was 31.5% in trial group and 18.7% in control group. It showed clinically group A is better than group B but the statistical difference between trial and control group is less i.e. 12.7% with P value 0.1277 which is not significant, thus it is indicated that statastically both trial and control group are equally effective in subjective parameters.

For objective parameters improvement was 9.5% in trial group and 5.8% in control group. It showed clinically group A is better than group B but the statistical difference between trial and control group is less i.e. 3.7% with P value 0.4781 which is not significant, thus it is indicated that statastically both trial and control group are equally effective in ojective parameters.

The total effect of study was obtained as 28.0% for trial group and 16.7% for control group. It showed clinically group A is better than group B but the difference between trial and control group is less i.e. 11.3% with P value 0.1572 which is not significant, thus the overall effect showed that statastically both trial and control group are equally effective.

Discussion on probable mode of action of Madhuyashti yog (Trial Drug)

Action on Panduta, Daurbalya, Gaurava, Aruchi, Aarohanayasa, Pindikodweshtana, Shwasa, Dravata hridayena

A prominent and the most important feature of Pandu roga is Panduta (pallor) on skin. Panduta occurs due to qualitative and quantitative deficiency of Rakta dhatu (blood tissues i.e. deficiency of haemoglobin or RBCs- red blood cells). Rakta dhatu, Pitta dosha and Oja are responsible for the Varna (complexion), Prabha (lusture), Kanti. So, due to rakta and pitta dusti oja also gets affected and there is a vitiation of Varna and Prabha and Panduta occurs over the skin.

In trial group, Madhuyashti drug possess Madhur rasa, Madhur vipaka and Sheeta virya which works as Pitta shamak and Raktaprasadak. Due to these properties of drug, trial group is able to reduced the symptom Panduta.

Daurbalyata prominently occur in Pandu rogi. The reason for this is Raktalpta and Ojakshaya which causes the debility to do anything. Depletion of blood tissue results in loss of body strength, weakness. In anemia the metabolic activities hamper due to deficiency of haemoglobin or RBCs- red blood cells & when this condition persists for a long period, debility appears.

In trial group, Madhuyashti has Balya, kshayahar, vishaghna (detoxification) and Rasayana properties. Due to these properties of drug, trial group is able to reduced Daurbalya.

Gaurava is a rasavahastrotodushti lakshana and rasavahastrotasa is affected in panduroga. Gaurava is also found due to strotorodha, dhatushaithilya.

In trial group, Madhuyashti possess Madhur rasa and vipaka due to which saptadhatuvardhana takes place which resulting into reducing rasavahastrotodushti lakshana like gaurava. Also madhuyashti is mild kaphachhedak, balya, kshayahar and rasayana properties. Due to this trial drug is able to reduced Gaurava.

Aruchi is a rasavahastrotodushti lakshana and rasavahastrotasa is affected in panduroga.

In trial group, Madhuyashti possess Madhur rasa, vipaka and sheet virya due to which saptadhatuvardhana takes place which resulting into reducing rasavahastrotodushti lakshana like aruchi. Also madhuyashti is mild kaphachhedak, balya, kshayahar. Due to this trial drug is able to reduced Aruchi.

Aarohanayasa is caused due to dhatushaithilya and daurbalya caused due to strotorodh.

In trial group, yashtimadhu possess balya, rasayan and vatahar properties. Due to these properties, trial drug is able to reduce aarohanaayasa.

In Pandu roga due to hampered metabolism dhatukshaya occurs due to which vata dosha get vitiated and causes pindikodweshtan (calf muscles cramp) Yashtimadhu drug has balya and   vatashamak properties due to Madhur vipaka therefore trial group is able to reduce Pindikodweshtana.

Shwasa symptom in panduroga occurs due to dhatukshaya, dhatushailya and vitiated vata.In trial group, the yashtimadhu churna possess kshayahar, vatahar and rasayan properties. Because of these properties of the drug, trial group is able to reduce Shwasa.

Dravata hridayena is occur due to vitiated vata caused due to daurbalya, dhatukshayata.

In trial group, the madhuyashti churna possess balya property and Madhura vipak which contributes to pacify vata dosha and provide strength to heart. Because of these properties drugs of the trial group is able to reduce Dravata hridayena.

Action on Objective parameter- Haemoglobin

Trial group- Madhuyashti acts on circulatory system by enhancing the blood flow and building red blood cells. Madhuyashti is a blood purifier and having haemopoetic action. Madhuyashti is said to be asrajeet. These properties of madhuyashti might have been helpful to increase the haemoglobin level.

Conclusion

At the end of this study, following conclusions can be drawn on the basis of literary aspect, action of drugs, observations and results achieved and through the discussion in the present context.

The primary objective has been achieved which was

“To compare the effectiveness of Madhuyashti yog and Guda Haritaki in the management of Pandu roga assessed by Haemoglobin level with special reference to Iron Deficiency Anaemia.”

“Madhuyashti Yog is clinically and statastically proven effective with significant P value in reducing subjective parameters i.e. Panduta, Daurbalya, Gaurava, Aruchi, Aarohanaayasa, Pindikodweshtana and Shwasa.

It is also statistically proven effective in improving the objective parameters i.e. Haemoglobin, with significant P value which is considered as the main parameter in evaluation of Iron Deficiency Anaemia.

Panduroga can be corelated with Anaemia (iron deficiency anaemia) due to its identical etiopathogenesis and clinical manifestations.

According to drug review it was concluded that the use of Madhuyashti yog was effective remedy for the management of Pandu roga.

By statistical analysis it is concluded that Madhuyashti yog shows

Significantly better effect than Guda Haritaki in following subjective parameter- Daurbalya, Gaurav, Aruchi .

While Madhuyashti yog and Guda Haritaki statistically proven equally effective in following subjective parameter-  Panduta, Aarohanaayaas, Pindikodveshtana, Shwasa, Dravata Hridayena and objective parameter Haemoglobin.

Comparison of total effect of subjective parameters, objective parameters and overall effect between trial and control group was statistically non-significant.

Statistically, on comparing the overall effect of trial and control group, it is concluded that Madhuyashti yog is equally effective as Guda Haritaki in the management of Pandu roga w.s.r. to iron deficiency anaemia.

References

1. Charak Samhita Vol 1 edited with “Vaidyamonarama” Hindi commentary by Aacharya Vidyadhar Shukla, professor Ravidutta Tripathi, Choukhamba Sanskrit Pratishthan, edition 2013; Sutra sthan Chapter; 28 Vividhashitpitiyo Adhyay, verse; 9 - 11, pg no.; 429
2. Sushruta Samhita Part-1 edited with ‘Ayurveda-Tattva-Sandipika’ Hindi commentary by Aacharya Kaviraj Ambikadutta Shashtri Choukhamba Sanskrit Sansthan, edition reprint 2017, Sutrasthana , Chapter; 24 Vyadhisamuddeshiya Adhyay, verse; 11, pg no.; 132.
3. Sushruta Samhita Part-2 edited with ‘Ayurveda-Tattva-Sandipika’ Hindi commentary by Aacharya Kaviraj Ambikadutta Shashtri Choukhamba Sanskrit Sansthan, edition reprint 2017, Uttartantram, Chapter; 44 Pandurog Pratishedh Adhyaay, verse; 23, pg no.373.
4.  Bhaishajya Ratnavali Chikitsasthan 12/4 Chikitsasthana, 12 pandurogachikitsa adhyaaya, verse 4 in dr. Ambikadatta shastri, editor. Bhaishajya ratnavali.
5. R.K. Sharma and Bhagwan Das, Carak Samhita, text with English translation and critical exposition based on Cakrapanidatta's Ayurved Dipika, Chowkhamba Sanskrit series office, Varanasi, edition, 2016, Chikitsasthan 16
6. R.K. Sharma and Bhagwan Das, Carak Samhita, text with English translation and critical exposition based on Cakrapanidatta's Ayurved Dipika, Chowkhamba Sanskrit series office, Varanasi, edition, 2016, Chikitsasthan 16
7. Stuart. H. Raltson, Ian D. Penman, Mark W.J. Strachon, Richard P. Hobson- Davidson’s Principles and Practice of Medicine 23rd edition pg no.;912 and 923.
8. Subhash Varma. Iron Deficiency Anemia. In: YP Munjal, editor-in-chief. API Textbook of Medicine Volume 19th edition. Mumbai: The Association of Physicians of India; 2012. Pg no.; 929.
9. NHFS 5 phase 2 pdf- https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf
10. http://Pubmed.ncbi.nlm.nih.gov/26404438