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Bull.Ind.lnst.Hist.Med. Vol. XXX - 2000 pp 1 to 14 PANDUROGA: A MEDICO - HISTORICAL STUDY

P.V.V. PRASAD"

ABSTRACT

According to the word '' denotes Pale or yellowish white colour. Panduroga (anaemia) is a disease in which man becomes Pallor due to deficiency of Rakta dhatu (blood) in the body. Rakta dhatu is mentioned among the Saptadhatus of the body. Historical importance ofPanduroga and a comparative study regarding its Nidana-Samprapti, , Upadravas and Chikitsa etc. as found in , , Charaka , , Chakradatta and Rajeeyam etc. are being presented in this paper.

Introduction: Regarding the aetiology, types, There are seven important constituents symptoms, complications and treatment of viz. , Rakta, Mamsa, Medo, Asthi, Panduroga a comparative study has been Majja and in the human body. They done based on Atharvaveda, Mahabharata, are known as "Sapthadhatu" in Ayurveda. , Sushruta Samhita, Amongst them Rakta (blood) is a very Astanga Hridaya, Astanga Sangraha, important dhatu. Sushruta has Madhava Nidana, Chakradatta, Bhava mentioned Rakta dhatu as fourth dosha of Prakasa Samhita and Basava Rajeeyam. In the body i.e. in addition to three doshas viz., addition to this, references were also Vata, Pitta and Kapha (Su.Sutra21/3). He collected regarding the usage ofLauha (iron) mentions that, Rakta is the life in living body. and Mandura and their preparations for Therefore it should be protected from all treating this important disease. types of vitiations and Pathogenic factors Atharvaveda : (Su. 14/44). Panduroga develops due This fourth and last veda of Indian to deficiency of blood in one's body. Ifit is literature gives information about Kamala not tackled in appropriate time can lead to (Jaundice) in the name of Harima or Kamala (Jaundice) and turns to be incurable. Panduroga (Kamala is the sequelae of The word 'Pandu' denotes pale-white or Panduroga) with literal meaning of yellowish - white colour. Panduroga is a "Yellowishness", At two places Harima has disease in which man becomes Pale. The been referred. Atharvaveda at XIX 44.2 word Pandu become more familiar ever since discusses about the Anjana and its efficacy :his was found in Mahabharata, one of the in treating Harima (Jaundice), Angabheda .two great epics of India. (aching of body), Visalpaka (Eczema),

• Research Officer (Ayurveda) Indian Institute of Ilistory of Medicine (CCRAS) Osmania Medical College Buildings, Putlibowli, I/yderabad. 2 Bull.Lncl lnst.l l ist, Med. Vol XXX - ]O(j()

Kshaya (Consumption) etc. At Hymn IX. Due to foresaid Nidana (aetiology) the 8.9 it is mentioned that the Harima and some aggrevated Pitta dosha will be propelled by other diseases like, abdominal colic, kshaya rakta in ten arteries which carry it to the (Phthisis) will be drived out by exertion. At whole body. This Pitta located in the space Hymn 1.22.1, it is mentioned that, Hridyota between tvak (Skin) and Mamsa (flesh) (heart disease) and Harima depart when sun affects Kapha, Vata, Rakta, tvak and Mamsa rises. It indicates, that sunrays will help to etc. and thereby produces various shades of treat Harima (It may be correlated with colours like pale yellow, deep yellow, and 'Phototherapy' which is used nowadays for green in skin. This condition is known as neonatal Jaundice). Seeds ofShuka trees and 'Panduroga' strong medicines also were used for the Premonitory symptoms of Panduroga treatment ofHarima (1.22.4.) It is interpreted include Hridaya Spandana (awareness of that Shuka trees are, Sirisha, Dadima, Shigru, heart beat), Rukshata (roughness), Kshiri, Jambu etc. and strong medicines are, Svedabhava (absence of sweat) and Gandhak, Sthauneyak, Talisha. (This Sramastha. (exhaustion). Symptoms offully interpretation is based on Astanga Sangraha). established Panduroga includes, Mahabharata : Kshvedi (tinnitus), Ajeema (loss of digestive As narrated in Mahabharata the father power), Daurbalya (Debility), Sadana, of was born Pale because, his (malaise) Annaddita (aversion to food), mother became quite Pale with fear Shrama (exhaustion), Bhrarna (giddiness), when in private with the sage and Nipeeda (Pain in body), Jwara (fever), Svasa named as Pandu (Panduraja) because of his (dyspnoea), Gauravam (heavyness) and Pale complexion. Aruchi (anorexia). Feeling of kneaded, Charaka Samhita : pressed or churned limbs. Moreover swelling In its Panduroga Chikitsadhikara (XVI on Akshikuta (orbit), Harital (green Chapter) of Chikitsa Sthana Panduroga has complexion), Sheerna lorna (falling of hairs), been described. Excessive intake of Kshara Hata Prabha (loss of lustre), Kopanah (alkaline), Amla (sour), Lavana (salty), (irritability), Sisiradveshi (aversion to cold) Ushna (hot), Viruddha (incompatible) and Nidralu (over sleepy) and Shteevana Asatmya (unsuitable) food, excessive use of (spitting). Alapavak (diminished speech), Nishpava (Dolichos lablab Linn.), Masha and Pindikodveshta (Pain in calves), Ruk (black gram), Tila(Sesamum) and its oil etc. (Pain) in whole body (waist thighs and legs) And in addition Divasvapna (day sleep), and Sadana (lassitude) are also seen exercises and sexual intercourse during the (Chikitsa Sthana 16112-16). digestion of food and lack of proper Acharya Charaka had mentioned five (5) management of evacuative measures, types of panduroga based on causative seasons and suppression of natural urges ( factors viz. 1) Vataja, 2) Pittaja, 3) Kaphaja, sexual desire. anxiety, fear, anger and grief), 4) Sannipataja (Tridoshaja) and have been mentioned as causative factors for Mritbhakshanajanyaja (Due to eating of soil! Panduroga. earth). 1) Vataja type presents with Panduroga : A Medico - Historical Study - Prasad 3

Pandutva (blackish paleness), troublesome. 5) Mritbhakshana Janyaja : It Ruksharunangata (roughness and is due to habit of eating earth. Kashayarasa reddishness of the body), Angamarda (body (astringent) of earth vitiates Vata, Kharaguna ache), Ruja (Pain), Toda (Piercing Pain), and Ksharaguna (rough and alkaline) viriates Kampa (trembling) Parshvasirorujah (Pain in Pitta, and Madhura rasa (sweet taste) vitiate sides of head), varchahsosha (dryness of Kapha In addition to this, earth obstructs the stools), Vairasya (distate in the month), srotas (channels) without undergoing any Sopha (oedema), Anaha (hardness in bowel) change and destroys bala (strength), ojas and Balakshaya (debility). 2) Pittaja Type (vigour) etc and produce Panduroga, which of Panduroga: Presents with Pita (yellow), further destroy the Bala (strength), Harita (greenish tinge), Jvara (fever) Daha (complexion) and (digestive fire) of (burning senation), Chardi (vomiting), the man. Patients may suffer from swelling Murcha (fating), Pipasa (thirst), Pita Mutra in cheeks, orbits, feet, navel, and genital (yellowish urine), and Pita Shakru (yellowish parts, as well as krimiroga and Atisara stools) and Patient with Pittaja Pandu (diarrhoea) with blood and mucus. (Chikitsa perspires profusely, may have desire for cold Sthana 16/1 7-30). and aversion to food. He may have pungency Charaka had clearly mentioned that in mouth, hot and sour things do not suit him Hridaya spandana (awareness of heart beat) "Arnla Udgara (acid eructations), Daurbalya is the symptom which is common to all (debility), Tama (feeling of darkness are also varieties of Panduroga (Chikitsa Sthana seen. 3) Kaphaja Type of Panduroga : 16/12). presents with Gauravam (heavyness), Tandra Regarding Kamala, Charaka says if a (drowsiness), Chardi (vomiting), patient of Panduroga, consumes Pitta Svetavabhasata (whitish complexion), aggrevating things excessively it may further Praseka (excessive Salivation), Lomaharsha vitiate Pitta and it bums blood, flesh and gives (horripilation), Sad a (malaise), Murcha rise to a disorder in which eyes, skin, nails (fainting), (giddiness), Klama and face become deep yellow, feces and urine (exhaustion), Svasa (dyspnoea), Kasa as red and yellow. Patient looks like a frog. (cough), Alasya (lessitude), Aruchi His senses and organs loose their functions, (anorexia), Vaksvaragraha (obstruction in associated with burning sensation, Avipaka speech and voice), Shukla mutra (whitish (indigestion), Daurbalya (debility), Sada urine), Shukla Akshi (whitish eyes), Shukla (malaise) and Aruchi (anorexia). This is Varchasa (whitish stools) and desire for known as Kamala. It is due to aggrevation pungent, and hot things, Svayathu (swelling), of Pitta. and is of two types I) Kosthasrit Madhurasya (sweetness in mouth) etc. 4) (located in belly) and 2) Sakhasrit (spread Sanni Pataja (Tridoshaja) :In those who use into bodyly parts through blood). Chronic all sorts of things, all doshas get vitiated and condition of Kamala leads to Kumbhaka- cause Panduroga, which presents with all mala (Jaundice located in belly) which is the above mentioned symptoms (Vataja, curable but with difficulty. The patient of Pittaja and Kaphaja) and it is said to be very Kamala succumbs soon to the disease iffeces 4 Bull.Ind.Inst.Hist.Med. Vol.xAX - 20()() and urine become black yellow, if there is of ingested food by strong evacuatives, then excessive swelling, blood in eyes, in the strength promoting ghritas should be mouth, in the vomiting, feces, urine, and also administered. If the patient does not desist ifhe faints and presents with thirst hardness from earth eating habit due to greediness, in bowels, drowsiness, confusion, loss of the earth should be given to him amply power of digestion and conciousness. impregnated with drugs which can destroy (Chikitsa Sthana 16/34-38). Another form its harmful effect such as Vidanga, Ela, known as Halimaka is also mentioned in Ativisha, Nimba leaves, Patha, Brihati fruit, Charaka Samhita. Its symptoms include, Katurohini, Indrayava or Murva (Chikitsa green, black and yellow complexion and loss Sthana 161117-122). of. Bala (strength and energy), Tandra Charaka had prescribed Lauha (iron) for (drowsiness), Mandagni (Poor digestion), treating the Panduroga in the formulation Mridujvara (mild fever), Strishvaharsha (loss known as Navayasa Churna (Chikitsa Sthana of desire for woman), Angamarda (body- 16/70-71) and administered iron socked with ache), Svasa (dyspnoea), (thirst), cow's urine for a week long with milk to Aruchi (anorexia) and Bhrama (giddiness). alleviate Panduroga. (16/69). Mandura (rust It is due to vitiation of Vata and Pitta of iron) also used for the same purpose i.e. (Chikitsa Sthana 161132-133). along with large number of herbs like, In the context of treatment part of Punarnava, Triphala, Trikatu, Chitraka, Panduroga, Charaka had clearly mentioned Katuki, Vidanga, Haridra etc. that it should be treated according to dosha Charaka had clearly mentioned that, if because of the specific Hetu (aetilogy) the patient of Panduroga with longer duration (Chikitsa Sthana 161123). has excessive roughness is not curable. The The principle for treatment of the curable Patient developing swelling due to chronic 'Panduroga' is that, initially, unction should Panduroga and if he percept all objects as be given to the patient. Then give strong yellow coloured, stool with mucus and green emesis and purgation. While in Kamala mild colour and if he has anxious expression, purgation with bitter drugs after the unction white and exessively smeared limbs, are advised. After evacuation both types of vomiting, fainting and thirst etc and if he cases should be managed with Pathyanna becomes white due to deficiency of blood is (wholesome diet) such as old sali rice, Yava also incurable .. (Chikitsa Sthana - 16/31-33). (barley) and Godhuma (wheat) with soups Sushruta Samhita : of Mudga (green gram), Adhaki (pigeon Acharya Sushruta had also given details pea), Masura (lentils) or meat soup of animals ofPanduroga in (44th chapter). and birds. Unction should be given with He has given some synonyms viz. Kamala, Panchagavya ghrita, Mahatiktaka ghrita or Apanaki, Kumbhahvaya, Lagharaka (or) Kalyanaka ghrita i.e. in both Panduroga and Laghavaka, and Alasaka (or) Alasakhya Kamala (Chikitsa Sthana 16/39-43). along with four, types of Panduroga i.e. I) While treating the Mritbhakshana Janya Vataja, 2) Pittaja, 3) Kaphaja and 4) ianduroga : A Medico - Historical Study - Prasad 5

- ioned as Purvarupa (premonitory symptom) Trishna (thirst), Sula (pain), Jvara (fever), for Panduroga. Other Purvarupas include Sopha (swelling) Daha (burning sensation), Tvak sphotana (cracks in the skin), Ajeerna (indigestion) Svarabheda (splitting Stheevana (excessive salivation), Prekshana of the voice) and Sad a (malaise) should be kutha sotha (swelling of the eyelids), treated on the same lines of treatment as yellowness of urine and feces and Mandagni mentioned separately for their management (indigestion (44/5,6) (Uttara Tantra 44/42). There is lot of similarity regarding Ashtanga Sangraha : N idana Samprapti (a etiopathogenesis), Vridha Vagbhata the author of this symptoms of Panduroga mentioned by classic has followed Charaka and Sushruta Charaka and Sushruta. There are some while mentioning Panduroga and its types, Upadravas (complications) according to symptoms, treatment etc. He had also Sushruta viz. Aruchi (aversion of food), prescribed Lauha and Mandura for Pipasa (thirst), (vomiting), Jvara Panduroga. According to him Sopha (fever) pain in Masthishka (pain in head), (swelling) is the main Upadrava. Kamala, Agnimandhya (loss of appetite), Sopha Kumbhakamala and Lodh ara / Halimaka are (swelling) and weakness in neck, oedema also mentioned in this classic. (Chikitsa in neck, Murcha (fainting), Klama (fatigue) Sthana, 8/6 7; Nidana Sthana, 13/17-21). and Pain in Hridaya (heart). Panduroga is Ashtanga Hridaya : incurable if the patient presents with swelling Panduroga with its Nidana Samprapti, in upper and lower limbs, face, scrotum, anus types symptoms and treatment have been and abdomen, fever, diarrhoea and if lying described by Vaghbhata in Nidana & in a sub commatose state. According to Chikitsa Sthanas (13th and 16th chapters Sushruta, Kumbhasahva is with swelling all respectively) in the same lines as in Charaka over the body and pain injoints. Lagharakal and Sushruta . He had also given Laghavaka is called when the cases of stress that, if Pandurogi consumes Katu Kamala are not treated and suffer (Pungent) and Ushna (hot) subtances he may from Jvara (fever), Angamarda (body ache), suffer from Kamala (Jaundice) and if it is Bhrama (giddiness), Tandra (dizziness), untreated swelling will develop, then it is decrease in the strength of the body and dhatu called Kurnbha Kamala. It is treatable but kshaya (decrease in bodly clements). with lot of difficulty. Halirnaka (Lodhar or Halimaka has also been mentioned as in Alasa) has also been described by him. Again Charaka Samh ita. Lauha and Mandura are found prescribed by Sushruta had also mentioned Lauha Vagbhata (Chikitsa Sthana 16/14, 15, 16-19) (iron) and Mandura (rust of iron) for Madhava Nidana: treatment of Panduroga aiong with severai Madhavakara, the writer of Madhava and herbo-mineral preparation. He Nidana had explained Nidana Sarnprapti of had also clarified that, complications of Pandu as like as Charaka and Sushruta. Panduroga Viz. Svasa (dyspnea). Atisara He also agreed that Kamala is the sequalae (diarrhoea), Aruchi (anorexia), Kasa (cough), of Panduroga. According to him 6 Bull.Ind.Inst.Hist.Med. Vol XXX - 2000

Kumbhakamala presents with Kamala, Basavarajeeyam (Text in Telugu swelling and pain in joints. Halimaka Language) : (chlorosis) is caused by Vata and Pitta doshas In this Basavaraju, the author of this text mainly. Jwara (fever), Angamarda (Pain in gives information about Panduroga and its the body), Bhrama (giddness) Tandra Nidana Samprapti, symptoms, treatment etc. (drowzines) and Dhatu Kshaya (emaciation in Panchama Prakarana, which is sim ilar with of the body are the symptoms (8/22-23). the description given by Charaka. Usage of Chakradatta : Lauha, Mandura bhasma is also found. Chakrapani Datta had given valuable Kamala, Kumbh ak am a la , have been treatment for Panduroga. Which contain described as sequelae of Panduroga (5/32- preparations with Lauha bhasma, Mandura 35; 60). Sushka (emaciated / dried) Pandu along with several other herbal drugs, for has also been mentioned (5/82). example, Haritaki Prayoga, Ayastiladi mo- Thus to conclude, Panduroga is an daka, Mandura Prayoga, Navayasa, Churna, important disease of mankind since time Vidangadhya louha. There is none more immemorial. There is almost a similar useful advice for a person who is suffering description of Panduroga regarding its from Panduroga, i.e. he should take milk Nidana Samprapti Lakshanas, Upadravas boiled in iron vessel for a week and he should and treatment in all Ayurvedic texts. Usage keep on having wholesome diet. (Panduroga of Lauha and Mandura bhasma is also found Chikitsa 8/5-7; 8/22, 9112 & 34). in all the texts. Only Sushruta has not Bhava Praksha Samhita : mentioned Mritbhakshana Janya Pandu as a In this, description ofPanduroga with its variety of Pandu roga, but mentioned as a N idana Samprapti, types, symptoms purvarupa (Premordial symptom). Therefore treatment etc is found. (Chikitsa Prakarana, ifPanduroga is not diagnosed early and left 8th Chapter) as in Charaka Samhita etc. Use untreated can lead to Kamala and complicate of Mandura, and lauha bhasma is also seen the prognosis, may become incurable and at (8/30 - 34 ; 35-38; 41). last may cause death. TYPES OF PANDUROGA ACCORDING TO DIFFERENT TEXTS :... ~ TYPE CHARAKA SUSHRUTA ASHTANGA ASHTANGA MADHAVA BHAVA - BASAVA - tl... SAMHITA SAMHITA SANGRAHA HRIDAYA NIDANA PRAKASHA RAJEEYAM g' l. Vataja + + + + + + +

2. Pittaja + + + + + + +

3. Kaphaja + + + + + +

4. Sannipataja + + + + + +

5. Mritbhakshana + + + + + Janya.

+ Mentioned

- Not Mentioned PREMONITARY SYMPTOMS OF PANDUROGA MENTIONED IN DIFFERENT TEXTS

'REMONITARY CHARAKA SUSHRUTA ASHTANGA ASHTANGA MADHAVA BHAVA - BASAVA - YMPTOM. SAMHITA SAMHITA SANGRAHA HRIDAYA NIDANA PRAKASHA RAJEEYAM

· Hridayaspandana + + +

· Roukshya and Redness + + + + + + +

· Svedabhava + +

· Akshi Kutha Sotha + + +

· Shrama + + +

· Bhrama tl:I ;: :- · Mritbhakshana + + + + :i'- ~ · Atisara :i' + + '" :J:::""' · Haritavarna Mala, Mutra - + + + + + + ~. ~ O. Avipaka I Ajeerna + + + + ~ ~ 1. Daurbalya + + + - ~ I + Mentioned I\.) c - Not Mentioned c~ s:"'"":, :::; ...,~ 0 :)Q SYMPTOMS OF PANDUROGA MENTIONED IN DIFFERENT TEXTS s::: ~ SYMPTOM CHARAKA SUSHRUTA ASHTANGA ASHTANGA MADHAVA BHAVA - BASAVA - SAMHITA SAMHITA SANGRAHA HRIDAYA NIDANA RAJEEYAM ~ PRAKASHA ~ <'l 0 I. Kama Kshvedi + + ::t:: 0:;' 2. Ajeerna + + 0..., ;::;-. s::: 3. Daurbalya + + + + -- ;:::~ 4. Atisara + + + + ~ ...,~ 5. Sad ana + s::, 's::": 6. Vamana + + + ~

7. Annadita + +

8. Shrama + +

9. Bhrama + + + + +

10. Nipeeda +

11. Jvara + + + + +

Cont..2 ...... • c:,

12. Kasa + + + + 13. Svasa + + + + 14. Pipasa + + + + + + 15. Gauravam + -+ + + + + 16. Karnpan + + + 17. Pindikodvesta + 18. Alpavak + + + 19. Daha + + + 20. Aruchi + + + + 21. Svayadhu + + + + + + 22. Anaha + + 23. Haritarn + + + + + bJ 24. Sheerna Lorna t ~ :-""- 25. Hatah Prabha + ~ ~ 26. Kopana + :i' '":-- 27. Sisira Dveshi + :t: 28. Nidralu I Tandra + + + + + ~. 29. Shteevana + + + + ~ ~ 30. Ruk (Ruja) + + + ~ ""- 31. Sadma + ~ + Mentioned c:,N c:, Not Mentioned c:, Panduroga : A Medico - Historical Study - Prasad 11

REFERENCES

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10. Srikantha Murthy, KR. 1995 Madhava Nidana (Rogavinischaya) of Madhavakara, English translation, Chaukhamba Orientalia, Varanasi - I, India

II. Wise, T.A. 1986 The Hindu system of medicine, Mittal Publishers & Distributors, Delhi -35, India

12. Yadunan Dass Upadhyay 1953 'Madhava Nidanam' (Sanskrit - Hindi), published by The Chaukhambha Sanskrit Series Office, Banaras, India.

13. Yaduna~ Dass Upadhyay 1950 Astanga Hridayam with Vidhyotini commentry by Gupta and published by Jaya Krishna Dass, Haridass Gupta, Varanasi - I, India. i'anduroga : A Medico - Historical Study - Prasad 13

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