Anaemia Pandu Roga Ayurveda Management

 

PANDU ROGA

 

What is Ayurveda approach to Anaemia?

 

 

Pandu Roga explained in Ayurveda can be co-related to Anaemia. Percentage of anaemia is growing even in developing countries because of the over consumption of adulterated and non-nutritious food mainly. According to Ayurveda, each and every tissue gets its nourishment from the nutrient portion of the food and hence the quantity and quality of blood tissue is dependent on the nutrient portion of food and the previous tissue lymph. Blood is responsible for longevity, nourishment, immunity, strength, contentment, happiness and for proper skin complexion. As blood originates from the liver and spleen, Pitta Dosha, blood and skin conditions are interrelated. This can be well understood from the disease anaemia explained in Ayurveda.

 

 

Ayurveda explains Pandu as a disease in which the body and colour of skin becomes pale resembling the pollens of Ketaki flower (Pandanus tectorius). Pandu is a serious condition which is chronic in nature. It is also known as Kumbhanyo or Lagharaka.

 

 

 

सर्वेषु चैतेष्विह पाण्डुभावो यतोऽधिकोऽतः खलु पाण्डुरोग । S.S.Utt. 44 / 4

 

स कामला पानकिपाण्डुरोगः कुम्भालयो लाघरकोलऽसाख्य विभाष्यते ।। S.S.Utt. 44 / 6

 

 

 

Bhekavarna is a term used for describing anaemia. Panduta means pallor, that is loss of normal colour of body or discolouration of skin.

 

 

Ayurveda Causative Factors for Anaemia

 

 

The causative factors of anaemia can be broadly divided into four types which are as follows.

 

1. Aharaja Nidana (Dietary factors)

 

• Kshara – Amla – Lavana – Ushna Ahara:  Excess intake of alkaline, sour, salty and hot food
• Viruddha Ahara, Asatmya bhojana: Too much consumption of incompatible food or unwholesome food.
• Nishpava – Maha – Pinyaka – Tila taila Nishevana: Use of cereals, sprouts, sesame seeds and sesame oil in excess

 

 

In the present era, we consume more fast food, junk food, bakery items which add onto the pathogenesis of anaemia. Excess intake of Pitta aggravating food items such as black lentil, spicy food items, etc. increases the Pitta in the body leading to Anaemia. Prolonged and more intake of sweet tastes, carbohydrates, clay produce anaemia. Frequent intake of unwholesome food items and incompatible food may inhibit the normal process of digestion by producing endotoxins known as Ama in the body leading to digestive disturbances which disrupts the assimilation also. Over use of sour tastes, hot and alkaline substances may injure the gastric mucosa first and then in combination with vitiated lymph tissue may lead to haemolysis and disturbed metabolism of various tissues following developing of anaemia. Astringent taste is an aetiological factor of anaemia mentioned in Harita Samhita.

 

 

Salty taste is mentioned as a causative factor of anaemia by Acharyas Charaka and Sushruta whereas sour taste is mentioned as a causative factor in all Ayurveda textbooks. Sour taste depletes the muscle tissue and causes looseness of the muscles. Salty taste vitiates the blood tissue. According to Acharya Susrutha, excessive intake of sour and salty tastes produce looseness of the muscles and joints and affects the complexion too. Excess use of wine and spicy food items aggravates Pitta Dosha and when they are used for a prolonged period of time, it causes pathological changes in the liver and stomach which will be observed in the form of gastritis or even ulceration ultimately producing anaemia by disturbing Ranjaka Pitta, one of the subtypes of Pitta Dosha which is responsible for imparting red colour to the blood.

 

 

Under nutrition that is poor eating habits, unhealthy snacks, increased fast food consumption and inadequate diet due to fast paced lifestyle can result in protein deficiency causing undernourishment of all tissues as well as deficiencies of vitamins and folic acid which can cause anaemia. These nutritional factors disturb the physiological formation and functioning of blood tissue leading to anaemia.  

 

 

1. Viharaja Nidana (Lifestyle factors)

 

• Ati Vyayama: Excess physical exertion
• Ati Maithuna: Too much indulgence in sex
• Divaswapna – Vidagdhe Anne Divaswapna: Sleeping during the daytime or sleeping when there is indigestion
• Vegadharana: Suppression of natural urges
• Mrid Bhakshanam: Pica – consumption of mud
• Madhyam: Excess intake of alcohol
• Ritu Vaishamya - Abnormal climatic changes
• Kama – Chinta – Bhaya – Krodha – Shoka: Negative emotions such as anger, grief, worries, etc.

 

 

Habits and lifestyle include both physical and mental activities. If one adopts unhealthy lifestyle and habits, it may compromise immunity which in turn affects the tissue health leading to the formation of anaemia. Excessive exercise, excessive sexual intercourse, increased physical activity leads to disturbance in the Dosha balance leading to anaemia. Likewise, suppression of natural urges and day sleep also disturbs the Doshas. Whereas climatic changes or abnormal seasons upset the normal functioning of the body. Mental activities like excess worry, grief, fear, anger leads to disturbance in the homeostatic condition of the body which also leads to anaemia. As majority of the persons suffering from anaemia fall in the lower or middle income groups, it can be understood that worry is also one of the important factor in all types of anaemia.

 

 

If a person has a habit of performing excessive exercise regularly, the metabolic activity of the body increases and the biochemical reactions are tented resulting in more production of carbon dioxide and water and liberation of energy which is utilised for the activity of the body during exercise. Thus it is seen that there is loss of energy from the body during severe exercise and if one does not take adequate amount of nutrition to compensate the loss, then naturally the requirements will be obtained from the tissue of the body itself and ultimately there will be general degeneration leading to diminution of the tissue health and ultimately depletion of Ojas or vitality. Moreover, due to increased tissue metabolism, there is tissue depletion again as is mentioned in Charaka Samhita.    

 

 

1. Anya Nidana (Other factors)

 

• PratiKarma - Erroneous application of Panchakarma
• Anya Vyadhi – Raktapradara Raktarbuda Raktarshas Grahani Krimi - Complication of other diseases such as menorrhagia, fibroids, bleeding haemorrhoids, ulcerative colitis, intestinal worms, etc.

 

 

In menorrhagia, fibroids, bleeding haemorrhoids and ulcerative colitis, there is loss of blood hence it can lead to anaemia if not treated on time. In irritable bowel syndrome and intestinal worms, nutrients are not properly absorbed hence may lead to anaemia.

 

 

 

 

 

Ayurveda Pathogenesis of Anaemia

 

Why do we get anaemia?

 

 

Due to overindulgence in the above causative factors, Pitta Dosha aggravates and invades the heart. Heart is the main centre for circulation of lymph and blood tissue. Then this aggravated Pitta Dosha is expelled from the heart because of the Vyana Vata, which is a subtype of Vata Dosha responsible for circulation and thus Pitta moves into the channels of circulation of lymph and blood tissue through the heart and hence reaches all over the body. Then the vitiated Pitta Dosha further aggravates lymph tissue and creates heaviness and lethargy in the body. There is loss of colour, complexion, glow of  the skin and loss of body strength as the vitiated Pitta reaches the space between the skin and muscle tissue. There is involvement of Kapha, Vata, blood tissue, muscle tissue and skin. Due to this the skin becomes pale or whitish discoloured.

 

 

According to Ayurveda, a tissue derives its nutrition from the digested food and preceding tissue. So as lymph tissue is vitiated, the succeeding tissue blood will also be malformed and depleted. Depletion of blood tissue naturally results in loss of body strength and fatigue.

 

 

Pitta Dosha and Blood tissue originate from Tejas or Fire. Aggravation of Pitta Dosha causes aggravation of blood tissue too because of the homogeneous properties. But as a matter of fact, the aggravation of Pitta Dosha brings diminution of the specific portion of lymph tissue which is responsible for the nourishment of the succeeding blood tissue, as a result of which there is no production of the nutrient factor to nourish the haemoglobin fraction of the blood.

 

 

Tejas is responsible for complexion too. However, the above explanation about blood tissues applies for Tejas also which means that Pitta is vitiated so it brings about vitiation of complexion too, leading to paleness. Also since the digestive fire becomes low because of the depletion of body strength, the metabolic fire is also compromised resulting in formation of immature tissues. Malnourishment occurs because of low digestive fire.

 

 

 

 

 

 

Source: https://www.ijmrpsjournal.com/Issues%20PDF/Vol.4/September-2017/6.pdf

 

Involvement of the Three Doshas

 

Although Pitta is the main Dosha vitiated, Vata and Kapha Doshas also play an important role in the manifestation of anaemia. According to Acharya Charaka, anaemia develops in a person when there is depletion of Vata Dosha because of the combined action of Pitta and Kapha. Anaemia can occur because of under nourishment or over nourishment which are explained below.

 

Apatarpana Janya Pandu (Anaemia due to undernourishment)

 

Excess intake of dry and light to digest food, sour, bitter and astringent tastes, non-nourishing diet, especially lack of iron in diet, fasting, excess strain, staying awake late at night, excessive exercise or sexual intercourse increase Vata Dosha in the body which in turn causes irregularity in digestive fire. This leads to vitiation of Pachaka Pitta, one of the subtypes of Pitta Dosha responsible for digestive process. As this Pitta is getting vitiated by already increased Vata Dosha and Agni is irregular, the digestion of food is hampered. Formation of lymph tissue is hampered because of this and it decreases qualitatively and quantitatively. This affects the quality and quantity of the succeeding tissue, blood which in turn leads to symptoms such as diminished strength, complexion, unctuousness / nourishment and Ojas or vitality. Thus in this type of pathogenesis Vata and Pitta Doshas are primarily vitiated and iron deficiency anaemia is caused.

 

Santarpana Janya Pandu (Anaemia due to over nourishment)

 

Here there is hampered iron absorption because of increased Kapha Dosha. Excess indulgence in heavy to digest, unctuous food items, predominant sweet, sour and salty tastes, over eating, excess sleep, sedentary lifestyle, etc. results in increase of Kapha Dosha in the body. Kapha Dosha is responsible for low digestive and metabolic fire. Thus Pachaka Pitta which is responsible for the digestive process gets vitiated due to low digestive fire caused by vitiated Kapha Dosha leading to improper digestion resulting in reduced quantity of lymph tissue. This in turn leads to decrease in the succeeding tissue, blood.

 

 

In general,

 

• Aggravated Vata Dosha is responsible for symptoms such as tremor, weakness, body pain, dryness, etc. because of the dryness and lightness properties of Vata.
• Pitta Dosha is responsible for normal colour of the body but when it vitiates the blood tissue as it happens in anaemia, there is loss of complexion or paleness of the skin. This is mainly caused because of the hot and sharp properties of Pitta Dosha.
• Kapha Dosha also plays a vital role in the development of anaemia. Aggravated Kapha Dosha is responsible for low digestive fire and endotoxin formation because of the dense, cold, stagnant properties of Kapha. Also other symptoms such as heaviness of the body, lethargy, low vitality, reduced speech, etc. are caused due to vitiation of Kapha Dosha.

 

 

Components of Pathogenesis of Anaemia

 

 

DOSHA	Pitta mainly, Kapha and Vata
TISSUES INVOLVED	Lymph and Blood
CHANNELS OF CIRCULATION INVOLVED	Lymph and Blood carrying channels
TYPE OF AFFLICTION OF SROTAS	Reverse flow and Obstruction
SEAT OF MANIFESTATION	Heart and Skin
NATURE	Slowly progressive
STATUS OF AGNI / DIGESTIVE AND METABOLIC FIRE	Low

 

 

 

Premonitory symptoms of Anaemia

 

 

According to Ayurveda, a disease develops gradually, hence if diagnosed and treated in the initial stages itself, treatment outcome will be good and further progression can be prevented. Following are the premonitory symptoms which precede the actual disease. Hence proper diagnosis and appropriate treatment at this stage will help in early and fast recovery.

 

 

• Hridaya Spandana: Palpitations
• Ruksha twacha: Dryness of the skin
• Gaatra Saada: Lassitude
• Mrid Bhakshana: Desire to eat soil
• Prekshanakoota Shotha: Swelling of eye sockets
• Vin – Mutra – Pitatva: Yellowish coloration of faeces and urine
• Avipaka: Indigestion
• Pippasa: Thirst
• Aruchi: Distaste
• Hrillasa: Nausea
• Urodaha: Burning sensation in chest
• Anga Gaurava: Heaviness of the body
• Rakta Lochana: Redness of eyes

 

 

Symptoms of Pandu Anaemia

 

 

The cardinal feature of anemia is Nakha – Nayana – Twak Panduta meaning paleness of the nails, eyes, skin, etc. Other symptoms explained in Ayurveda texts are as follows.

 

• Ojo Guna Kshaya: Low vitality
• Alpa Rakta Meda: Reduction in normal quality and quantity of blood tissue and fat tissue
• Kopana: Anger, irritation
• Alpa Vaak: Reduced speech reduced speech because of weakness
• Hrid Dravata: Palpitations
• Sadana: Severe weakness
• Sannasaktha: Weakness of thighs
• Karna Ksvedi: Buzzing in the ears
• Hata Anala: Low digestive fire
• Shoona Akshi Koota: Swollen eye sockets
• Shishira Dveshi: Intolerance to cold
• Hata Prabha: Decreased complexion
• Srama: Lethargy
• Shwasa: Dyspnoea

 

 

Involvement of vitiated lymph tissue causes the following symptoms –

 

• Jwara: Fever
• Anna Dvesha: Aversion towards food
• Brama: Drowsiness
• Gaurava: Heaviness
• Panduta: Paleness

 

Involvement of vitiated blood and lymph tissue causes –

 

• Gaatra Shula: Crushing type of pain in the body.

 

Vitiated muscle tissue involvement causes –

 

• Karshya: Emaciation

 

 

Classification of Pandu Anaemia as per Ayurveda

 

There are 5 types of anaemia explained in Ayurveda texts. This classification is based on the predominance of doshas. Although one type of Pandu named Mrid Bhakshana Janya Pandu develops because of eating soil, the soil quality causes aggravation of any of the three Doshas and finally causes Dosha dominant type of Pandu.

 

 

1. Vataja Pandu – Due to excess indulgence in Vata aggravating factors such as excess intake of dry food items, overstrain, staying awake late at night, there is vitiation of vata which in turn combines with lymph tissue and causes Vata dominant type of anaemia. The symptoms include –

 

• Ruksha Khara Twak: Dryness and roughness of the skin
• Kampa: Tremors
• Parshva Shula: Pain in the flanks
• Shirashula: Headache
• Varcha Shosha: Constipation
• Asya Vairasya: Dryness in the mouth
• Bala Kshaya: Lassitude
• Bhrama: Giddiness
• Anaha: Abdominal distension
• Shopa: Oedema
• Toda: Pricking type of pain in the body
• Twak Nakha Mukha Nayana Mutra Maladinaam Ruksha Krishna Arunabha: The colour of the skin, nails, face, eyes, urine and stool becomes dry and greyish black.

 

1. Pittaja Pandu – When a person follows Pitta vitiating diet and lifestyle such as too much sunbathing, excess intake of spicy and hot food items, there will be aggravation of Pitta dosha which in combination with lymph tissue produces Pitta dominant type of anaemia. The symptoms include -

 

 

• Jwara: Fever
• Daha: Burning sensation
• Trishna: Increased thirst
• Murcha: Stupor
• Pita Mutra Shakrt: Yellowish tinge of the urine and faeces
• Swedana: Sweating
• Amla Udgara: Sour belching
• Vidaha: Acidity
• Katu Asyata: Rancid feel of the mouth
• Vidagdha Anna: Indigestion
• Durgandha Bhinna Varcha - Mutra: Foul smelling and broken faeces and foul smelling urine
• Daurbalya: Weakness
• Ushna – Amla Dvesha: Aversion to hot and sour food
• Shita Kama Annam Abinandi: Desire for cold surroundings and cold food items.  
• Pita Haritabha Twak Nakha Nayana Mutra Shakrt: Yellowish green discolouration of the skin, nails, eyes, urine and faeces.

 

 

1. Kaphaja Pandu - Kapha dosha aggravates because of excess intake of Kapha increasing diet such as dairy products, sugar, etc. and following Kapha vitiating lifestyle like sleeping during daytime and having sendentary lifestyle. This aggravated Kapha Dosha combines with lymph tissue to form the dominant type of Kapha dosha of Pandu. The symptoms include -

 

• Praseka: Excess salivation
• Lomaharsha: Horripilation
• Bhrama: Giddiness
• Shwasa: Dyspnoea
• Kasa: Cough
• Alasya: Lethargy
• Murcha: Stupor
• Aruchi: Distaste
• Vak Svara Graha: Obstructed voice and difficult speech
• Saada: Debility
• Klama: Fatigue
• Shukla Twak Akshi Mutra Varcha: Whitish tint of the skin, nails, eyes, urine and faeces 
• Katu Ruksha Ushna Kamya: Desire for hot, spicy, tangy and fried dishes. 
• Madhura Asyata: Sweet taste in the mouth
• Shwayathu: Oedema

 

 

1. Sannipatika Pandu - Over indulgence in causative factors that increase all three Doshas lead to this type of anaemia. As all the three Doshas are vitiated, this is a serious type of anaemia when compared to the other types. Following are its symptoms.

 

• Jwara: Fever
• Shotha: Oedema
• Hrillasa: Nausea
• Kasa: Cough
• Vit Bheda: Unformed faeces
• Parusha Nayana: Dryness of eyes
• Moha: Delirium
• Alasya: Lethargy
• Chardi: Vomiting
• Trishna: Thirst
• Arochaka: Distaste
• Kshina: Loss of strength
• Kshudhartha: Excess appetite or constant feeling of hunger
• Klama: Fatigue

 

 

1. Mrid Bhakshana Janya Pandu - This type develops in one who is prone to eat soil. Many times children and elderly too eat soil due to ignorance. Soil can be of different tastes. Intake of soil having sweet taste increases Kapha, soil having alkaline taste aggravates Pitta and soil having taste astringent taste vitiates Vata. Thus respective Doshas get aggravated and relevant type of anaemia is caused. Depending upon the taste of clay which enters the gastrointestinal tract, it makes the tissues dry and causes loss of complexion and glow. Also the soil cannot be processed even slightly by the digestive fire for digestion and it gets in the channels carrying lymph issue in the same form it was consumed and it forms an obstruction in the channels of circulation of lymph tissue not to allow any physiologically needful substance to pass through. By this, the nutrition is compromised and the sense organs of the person becomes weaker to perceive the objects of the sense organs properly and genuinely. This also damages the essence of the other tissues and digestive fire as well. Following are the symptoms of this type of anaemia.

 

 

• Poorayat Avipakvaiva Srotamsi Nirunnadhi: Obstruction to the channels of circulation because of clogging of mud in it
• Indriyanam Balam Hatva: Loss of strength of the sense organs
• Teja Oja Hata: Decrease in vitality
• Bala Varna Agni Nashana: Decrease in digestive power, strength and complexion
• Shoona Akshikoota Bhru: Oedema around eyes and eye brows
• Shoona Pada Nabhi Mehana: Swelling of the legs, umbilicus and genitals
• Krimi Koshta Atisaararyeta Malam Saasruk: Loose, unformed, sticky and blood stained stools

 

 

Ayurveda Treatment Approach for Pandu Anaemia

 

 

Ayurveda management involves elimination of the vitiated Pitta Dosha, downward movement of Vata Dosha and clearing obstruction in the channels of circulation thereby restoring tissue nourishment. Treatment approach involves the following four steps.

 

1. Nidana Parivarjana, that is avoidance of causative factors.

 

1. Snehana - Swedana: Oleation and fomentation therapies to prepare the body to receive Detoxification

 

Panchakarma follows preparatory procedures Abhyanga (Ayurvedic massage), Swedana (Sudation) and Snehapana (Oral administration of medicated ghee) with Mahatiktaka Ghrita or Kalyanaka Ghrita for 5 to 7 days based on one’s physical strength and status of digestive fire. Proper oleation of the body helps in downward movement of Vata, corrects the functioning of Agni, lubricates the body and imparts softness to the skin and oiliness to the stools.

 

1. Shodhana: Detoxification to help in elimination of factors responsible for producing the disease

 

Based on the strength of the person, suitable Panchakarma therapy is planned. Panchakarma, mainly Vamana (Therapeutic emesis) and Virechana (Therapeutic purgation) with herbs having unctuous and sharp properties will help in cleansing the body by eliminating obstruction in the channels of circulation. Vamana helps in removal of obstruction through the upward tract and helps in balancing Kapha Dosha mainly, whereas Virechana helps in removal of endotoxins through the downward tract and helps in balancing Pitta Dosha mainly. However in anaemia, as both these Doshas are involved, both Vamana and Virechana are suggested. One Panchakarma is performed at a time, so after Vamana, following a period of rest and suitable post Panchakarma diet, again massage, steam bath and oral administration of ghee is done. Then Virechana is planned. Vamana is administered using lukewarm milk mixed with cane sugar, paste of Madanaphala, that is emetic nut and decoction of Yashtimadhu. Virechana is administered using milk alone or Trivrit powder mixed with cane sugar or infusion of Danti mixed with paste of raisins.

 

 

After Panchakarma, suitable diet is given. Special rice which is harvested in sixty days, known as Shali Anna, barley, wheat mixed with soup of green gram, pigeon pea, orange lentil and vegetables are advised. Also medicated ghee is suggested following Panchakarma for promotion of body strength.

 

1. Shamana: Pacification treatments to correct deficiency

 

For Vataja Pandu, use of unctuous substances like medicated oil, ghee is suggested. For Pittaja Pandu, bitter and colling herbs are suggested and for Kaphaja Pandu, pungent, bitter and hot potency herbs are used for treatment.

 

Hot potency herbs help to improve the digestive and metabolic fire. Herbs having light to digest, dry, unctuous properties improves the blood tissue qualitatively and quantitatively. Pungent and bitter tastes increase blood tissue and enhance the absorption of iron. Appetizers and digestives help to improve digestive fire and increase the bioavailability of iron. Herbs that are appetizers, rejuvenating agents, restore the tissue strength, strength promoting, helps in increasing blood tissue, especially the haemoglobin component, helps in bioavailability of iron and increases iron absorption and enhances the production of red blood cells are used in the management of anaemia.

 

In order to give up the soil eating habit, one is given herbs mainly Vidanga, Ela, Ativisha, Nimba Patra, Patha, Vartaka, Katurohini, Kutaja and Murva. These help to develop aversion to soil and they also counteract the adverse effects of eating soil. Depending upon the Dosha predominance, suitable herbs and therapies are given to the person suffering from Mrid Bhakshana Janya Pandu. Treatment of this type of anaemia needs special approach because of the specific nature of causative factor.

 

• Medicated Ghee: Pathya Ghrita, Draksha Ghrita, Vyoshadya Ghrita, Danti Ghrita
• Medicated Powder: Navayasa Churna
• Tablets: Punarnava Mandura, Shilajit Vataka, Mandura Vataka
• Linctus: Dhatri Avaleha
• Fermented Liquid preparation: Dhatryarishta

 

 

Triphala is a rejuvenative. Amalaki is rich in Vitamin C which helps in iron absorption in the body. Trikatu helps to improve Agni, thereby improving tissue nourishment. Hence these are beneficial in the management of anaemia.

 

Regular massage with Bala Ashwagandha oil or Kshirabala oil is beneficial. Sarvangadhara or Oil bath is nourishing.

 

 

Ayurveda natural Diet and Lifestyle for Anaemia

 

 

 

तत्र पाण्ड्वामयस्निग्धास्तिक्ष्णैरूर्वानुलोमिकैः ।
संशोध्यो मुदुभिस्तिक्तै: कमली तु विरेचनैः ॥
ताभ्यां संशुद्धकोष्ठाभ्यां पथ्यान्यान्नानि दापयेत् ।
च.चि.१६/४०-४१

 

 

Pathya Wholesome Diet	Apathya Unwholesome Diet
Light to digest food items Astringent taste Whole grains, Shali rice which is harvested in 60 days, Barley, Wheat Green gram, orange lentil, pigeon pea, dried beans Vegetable soup Sugarcane Cow’s ghee, buttermilk Garlic, Pumpkin, Brinjal, Bottle gourd, Ivy gourd Mango, Banana Fish Curcuma, Saffron, Parsley Dried Apricots, Prunes, Raisins, Dry fruits	Heavy to digest food items Food that cause burning sensation Spicy and Salty food Black lentil Asafoetida, Mustard, Red chilies Coffee, tea, soft drinks, red wine Ice cream, chocolates

 

 

 

Pathya Vihara or Wholesome Lifestyle	Apathya Vihara or Unwholesome Lifestyle
Rest Massage	Sudation, Sun bathing Suppression of urge to vomit Over exertion Excess physical exercise Day sleep

 

 

 

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