Charaka Pandu Roga Chikitsa – 16th Chapter

The 16th chapter of Charaka Samhita Chikitsa Sthana is called Pandu Roga Chikitsa. It deals with causes, symptoms and treatment of anaemia, jaundice and other liver disorders. Chapter 16
Let us explore the chapter on the Treatment of Panduroga.
Thus said Lord Atreya [1-2]

Types

Types of Pandu Roga
Pandu – Roga is of 5 varieties as follows:
1. Vataja Pandu caused by Vata Dosha
2. Pittaja Pandu caused by Pitta
3. Kaphaja Pandu caused by Kapha
4. Sannipatika PanduRoga caused by the simultaneous aggravation of all the 3 Doshas (Sannipatika) and
5. Mrut Bhaksha Janya Pandu Roga caused by eating clay or Mrttika (Geographism) [3]

Read related: Liver Diseases: Causes, Symptoms, Treatment, Home Remedies

Pandu Samanya Samprapti

When the Doshas, with Pitta as the dominant one are aggravated in the Dhatus, then the Dhatus get afflicted. This results in weakening (Shithila) and heaviness (Gaurava) of Dhathu – body tissues.
Thereafter, the complexion, strength and unctuousness, and the properties of Ojas get reduced on account of the vitiation of the Doshas and Dhatus.
The patient becomes
poor in blood – Alpa Rakta
low in fat tissue – Alpa medaska
Nissara – lack of vitality:
Shithilendriya – His sense organs become weak: and he suffers from discoloration, leading to manifestation of Pandu Roga.
The etiology and pathogenesis and the signs including symptoms of this disease will be explained hereafter. [4-6]

Causes, pathology

Causes and pathology of Pandu – Anemia / initial stages of liver disorders:
Pitta gets aggravated by the following:
1. Excessive intake of Kshara, sour, saline hot and mutually contradictory food, unwholesome food, Nishpava (cow pea) Masha Pinyaka (oil cake) and tilaoil.
2. Sleeping during day time, and exercise as well as sexual intercourse when the food is not properly digested (Vidagdha Anna)
3. Improper administration of Panchakarma therapies and transgression of prescribed seasonal regimens (rutu-vaishamya) and
4. Suppression of natural urges

In a person with his mind afflicted with worry, fear, anger and grief. Such aggravation of Pitta located in the cardiac region takes place, then this Pitta being forcefully propelled by Vata Dosha, enters in to the 10 vessels [attached to the heart] and circulates in the entire body.

Being located between the skin and the muscle tissue, this aggravated Pitta vitiates Kapha, Vayu, Asruk (blood), skin and muscles as a result of which different types of coloration, like Pandu (pale yellow), Haridra (yellow) and Harita (green) appear in the skin. This is called Pandu Roga (a type of Anemia) [7-1/2 12]

Purvaroopa

Pandu roga purvaroopa:
The premonitory signs and symptoms of Pandu are:
Hrudaya spandana – palpitation
Raukshyam – dryness
Sweda abhava – absence of sweating and
Shrama –fatigue [12 ½]

Samanya Lakshana

Pandu Roga Samanya Lakshana – General symptoms:

General symptoms:
Any of the varieties of Pandu Roga leads to below listed general symptoms.
Karna Kshveda – tinnitus
Hata anala – suppression of the power of digestion
Durbala – weakness
Sadana – prostration
Anna divshta – repugnance against food
Shrama – fatigue
Bhrama – giddiness
Gatra shoola – pain in the body
Jwara – fever
Shwasa – dyspnoea
Gaurava – heaviness and
Aruchi – anorexia
Mrudita gatra – He feels as if all the limbs of his body are being kneaded, squeezed and churned.
Shunakshi koota – He suffers from swelling of the orbital region
Harita sheerna – His complexion becomes green.
Loma hata prabha – The small hair of his body fall out: he loses his bodily lustre:
Kopana – he becomes irritable: he avoids speaking:
Pindiko dveshtana – he suffers from cramps in the calf region: and while making efforts for climbing,
Kati ura pada ruk sadana – he suffers from pain and weakness in the lumber region, tights and feet.

The signs and symptoms specific to each variety of Pandu will be described hereafter. [13-16]

Vataja pandu

Vatika Pandu Nidana, lakshana

Etiology, Signs and Symptoms of Vatika Pandu:
Vata gets vitiated by the Vayu- aggravating diet and regimen which brings about
Krshna pandu anga – black and pale-yellow complexion,
Ruksha anga – dryness,
Aruna anga – reddish discolouration of the body,
Anga marda – malaise
Ruja – ache
Toda – pricking pain
Kampa – tremor
Parshav ruja – pain in the sides of the chest,
Shiro ruja – headache
Varcha Shosha – dryness of feces
Mukha Vairasya – distaste in the mouth,
Shopha – swelling,
Anaha – constipation and
Bala kshaya – Weakness [17-18]

Pittaja Pandu

Pittaja pandu Nidana, Lakshana
Etiology, signs and Symptoms of Paittik Pandu:
If a person of Pitta body type indulges in Pitta increasing diet and regime, then increased Pitta vitiates blood and causes Pittala type of Pandu roga giving rise to below signs and symptoms:
1. Peeta Harita Varna – complexion becomes yellow or green
2. Jwara Daha Samanvitah – fever and burning sensation
3. Trushna Murccha Pipasa – Faints, because of excessive thirst and suffers from morbid thirst
4. Pita mutra – His urine and stool becomes yellow in colour
5. Svedanah Sheeta kamita – Sweating and develops longing for cold things
6. Annam Abhinandati – He does not relish food
7. Katuka Aasya – Feeling pungent taste in mouth and
8. Ushna Upashete Amla meva cha – hot and sour things do not suit him
9. Amla udgara – sour eructation and
10. Vidaha Vidagdhe Anne – burning sensation due to indigestion of food
11. Mukha Daurgandhya – bad breath and
12. Bhinna varchas, Daurbalyam, tama eva cha – He gets loose motions, weakness and fainting. [19-22]

Kaphaja Pandu

Kaphaja Pandu Nidana, Lakshana:
Etiology Signs and Symptoms of Kaphaja Pandu:
Kapha vitiated by its aggravating food and drinks gives rise to Kaphaja type as per the pathogenesis described before.

The signs and symptoms of this type of Pandu are as follows:
1. Gauravam – Heaviness,
2. Tandra – Drowsiness,
3. Chardim – Vomiting,
4. Shvetavabhasa – whitish complexion,
5. Prasekam – Salivation,
6. Loma harsha – Horripilation,
7. Murchha- fainting,
8. Bhrama – Giddiness,
9. Klama – mental fatigue,
10. Shvasa – dyspnoea,
11. Kasa – cough,
12. Aalasya – laziness,
13. Aruchi – anorexia,
14. Vaksha savara graham – obstruction in speech and voice,
15. Shukla akshi varchas – whitish discolouration of urine, eyes and faces
16. Katu ruksha ushna kamata – Longing for pungent, unctuous and things and
17. Shwathu – Oedema and
18. Madhura aasya – sweet taste in the mouth. [23-25]

Tridoshaja Pandu

Etiology, Signs and Symptoms of Tridoshaja Pandu Roga:

If a person indulges in all types of unwholesome food, then all the 3 Doshas get vitiated to cause Tridoshaja Pandu. This type of Sannipatika Pandu is extremely intolerable (difficult of cure). [26]

Mrud bhakshana janya Pandu

Mrud-bhakshanaja Pandu Nidana, Lakshana:

Mrut Bhakshan Janya Pandu – Anaemia due to mud eating:
Habitual indulgence in eating clay (Mrttika) aggravates one of the 3 Doshas.
If the mud is of astringent taste, then it aggravates Vayu: if it is saline with alkaline as subsidiary taste, then Pitta gets aggravated: and if it is sweet in taste, then Kapha gets aggravated.
Because of its dryness, the clay (Mrut) causes dryness in the Rasa Dhatu (Chyle) and the ingredients of food. Thus, the undigested clay, i.e in its crude form, fills up the channels of circulation and blocks them. It afflicts the sharpness of senses, lustre, energy and Ojas which results in the loss of strength, complexion and Agni (power of digestion and metabolism).

In this type of Pandu, the signs and symptoms manifested are as follows:
1. Shuna ganda akshi kuta – Oedema in the cheek, eye sockets and eye bones
2. Oedema in feet, umbilical region and the pudendum
3. Krimi koshta – Appearance of worms in Kostha (intestine) and
4. Atisara – Loose motions, the stool being associated with blood and mucus (Kapha).[27-30]

Prognosis

Prognosis – Pandu Upashaya:
Signs and symptoms indicating incurability of Panduroga are as follows
1. The disease becomes chronic
2. Excessive dryness has appeared in the patient
3. When the patient has oedema owing to chronicness of this diseases
4. When the patient gets yellow vision
5. When the patient is fully or partially constipated
6. When the patient passes loose stool which is green in colour and which is mixed with mucus
7. When the patient feels exceeding prostrated
8. When the body is exceedingly white as if besmeared ( with whiteness)
9. When the patient is exceedingly afflicted with vomiting fainting and morbid thirst and
10. When the body of the patient becomes pale on account of loss of blood. Such a patient never survives
Thus, the signs and symptoms of all 5 types of Pandu Roga (Vatika, Pittaja, Kaphaja, Sannipatika and Mrd-Bhaksanaja) are discussed. [31-33]

Kamala (Jaundice)

If the patient suffering from Pandu indulges in Pitta aggravating diet and regimen, the Pitta so aggravated burns the Rakta (blood) and Mamsa (Muscle tissue) to cause the disease Kamala [Jaundice].
The signs and symptoms of Kamala are as follows:
Haridra Netra – yellowish discolouration of sclera of eyes
Haridra twak, Nakha, Anana – yellowish discoloration of skin, nails and face
Urine and feces turns red and yellow
Bheka Varna – He develops complexion like that of a frog
Hatendriya – sense organs are impaired and
Daha – burning sensation
Avipaka, Aruchi – indigestion, anorexia
Daurbalya, Sadana – weakness, bodyache

Kamala disease is caused by excess of Pitta. It is of two types-
Koshtashrita Kamala – one is located in the gastro- intestinal tract (
Shakhashrita Kamala – located in the peripheral tissues (Sakhashraya). [34-36]

Kumbha Kamala

After some time if not treated properly, the Kamala [Jaundice] becomes deep-seated (Kharibhuta – roughened, hardened) and thus, becomes difficult of cure. This condition is called Kumbha-Kamala (a type of Jaundice).
The signs and symptoms of this Kumbh Kamala are:
1. Krishna pita shakrut mutra – The stool and urine of the patient become black and yellow
2. Bhrusham shunashcha manavah- Excess of oedema in the body
3. Sa Rakta Akshi, Mukha – Blood appears in the eyes and face of the patient
4. Chardi vin mutro rakta – The vomitus, stool and urine are mixed with blood
5. The patient develops tremors
6. Daha, Aruchi, Trushna, Anaha,Tandra, Moha – He is afflicted with burning sensation, anorexia, morbid thirst, constipation drowsiness and fainting and
7. Nashta Agni – He loses Agni (the power of digestion and metabolism) and consciousness.
A person having this type of Kumbha-Kamala succumbs to death quickly. [37-1/2 39]

Chikitsa Sutra

Panduroga Chikitsa Sutra – Line of Treatment:

Line of Treatment:
Now the treatment for curable patients of Pandu Roga and Kamala (Jaundice) are being described.
The patient suffering from Pandu Roga is given –
Vamana – emetic therapy and
Virechana – Purgation therapies with Snigdha – unctuous and Teekshna – sharp drugs for the cleansing of his body.

The patient suffering from Kamala (jaundice) is given Virechana – purgation therapy with mild and bitter medicines.
After the gastro-intestinal tract is cleansed by the above mentioned elimination therapies, patient is given wholesome food containing old rice, barley and wheat mixed with the Yusha (vegetable soup) of Mudga (green gram), Adhaki (pigeon pea) and Masura (lentil) and the Jangala Mamsarasa (meat soup) of animals inhabiting arid zone.
On the basis of Doshas aggravated to cause these diseases, specific medicines are to be administered to these 2 categories of patients (which will be described later in this chapter)
For the purpose oleation, the patient suffering from Pandu Roga (Anemia) and Kamala (Jaundice) is given Panchagavya Grutha,
Maha-Tikta Ghruta and
Kalyanaka- Ghruta. [39 ½ -43]

Dadimadya Ghrita

Dadimadi Ghrita: (Click to read more about its uses, side effects, dose etc)
20 Palas of ghee is cooked by adding 1 Adhaka of water, and the paste of 1 Kudava of Dadima – Punica granatum,
½ Kudava of Dhanya
1 Pala of each of Chitraka – Plumbago zeylanica and Srngavera and
1 Astamika of Pippali- Piper longum
This medicated ghee stimulates the power of digestion.
It is useful in curing
Shwasa – Asthma
Kasa – bronchitis
Mudha-Vata (Claudication of Vayu) and
Dukha-prasava (difficult labour)
It also helps a sterile woman to beget an offspring.
Thus, ends the description of Dadimadya –Ghrta [44-46]

Katukadya Ghritham

 1 prastha (768 g) of ghee is cooked by adding 4 Prasthas of milk and
The paste of 1 Pala each of
Katuka – rohini – Piccrorhiza kuroa
Musta – Cyperus rotundus
Haridra – Berberis aristata
Daru- Haridra – Berberis aristata and
Vatsaka and
1 Karsha – 12 g of each of
Patola – Trichosanthes dioica
Chandana – Santalum album
Murva – Marsedenia tenacissima
Trayamana
Duralabha
Krishna – Long pepper,
Parpataka – Fumaria indica
Nimba – Azadirachta indica
Bhunimba – Phyllanthus niruri and
Devadaru – Cedrus deodara
This medicated ghee cures
Raktha-Pitta (a disease characterized by bleeding from different parts of the body),
Jwara – fever,
Daha – burning syndrome,
Shotha – oedema,
Bhagandara- fistula-in ano,
Arshas – piles,
Arsgdara – menorrhagia and
Visphotaka (a disease characterised by pustular eruptions in the body).
Thus, ends the description of Katukadya Grtha [47-49]

Pathya Ghruta

1 Prastha of ghee is cooked by adding decoction of 100 fruits of Haritaki – Terminalia bellerica, and the paste of 50 of Haritaki- Terminalia bellerica fruit.
This medicated ghee cures Pandu (Anaemia) and Gulma (Phantom tumour)
Thus ends the description of Pathya- Ghrta [50]

Danti Ghrita

Accordingly, 1 Prastha of ghee is cooked by adding 1 Prastha of the decoction of 4 Palas of Danti, and the paste of the cut-pieces of green fruits of danti.
Intake of this medicated ghee cures
Plihan – Splenic disorders
Pandu – Anemia and
Shopha – oedema.
Thus, ends the description of Danti- ghruta [51]

Draksha Ghruta

1 Prastha of old ghee is added with ½ a Prastha of Draksha – Vitis vinfera and cooked.
This medicated ghee cures
Kamala – jaundice
Gulma – Phantom tumour
Pandu – Anaemia,
Jwara – fever,
Meha – obstinate urinary diseases including diabetes and
Udara – obstinate abdominal diseases including ascites
Thus ends the description of Draksha ghrta [52]

Haridradi Ghrta

Ghee collected from buffalo milk is cooked by adding milk and [the paste of] Haridra – Berberis aristata, Triphala, Nimba – Azadirachta indica, Bala – Abution indicum and Madhuka – Madhuca longifolia.
This medicated ghee is an excellent recipe for the cure of Jaundice.
Thus, ends the description of Haridradi Ghrta. [53]

Two recipes for medicated Ghee
1 Prastha (768 g) of ghee collected from buffalo milk is boiled by adding 2 Prasthas of Cow’s urine, and 2 Aksas of the paste of Darvi, this medicated ghee cures Pandu- Roga (Anemia).
1 Prastha of the ghee collected from buffalo milk is boiled by adding the decoction of 5 Palas of Darvi and the paste of Kaliyaka.
This medicated ghee cures Kamala (jaundice) [54 -¼ 55]

Virechana – Purgation therapy

After the patient is been properly oleated by the intake of the above mentioned recipes of medicated ghee, he is given purgation therapy frequently with the following recipes:
1. Milk added with cow’s urine
2. Milk alone
3. Luke- warm infusion of Darvi sprinkled with the powder of 1 Anjali of Kasmarya (fruit of Gambhari – Gmelina arborea) of mixed with the paste of 1 Anjali of Draksa – Vitis vinfera
The above mentioned recipes cure Pandu- Roga ( Anaemia) in general.
4. The patient suffering from Paittika type of Pandu- Roga should take ½ Pala of the powder of trivrt – Operculina turpethum mixed with 1 Pala of sugar.
5. The patient suffering from Kaphaja type of Pandu- Roga should take haritaki – Terminalia chebula impregnated with cow’s urine.
The patient suffering from Kamala (Jaundice) should take Aragvadha – Cassia fistula added with Sunthi – Zingiber officinale, Pippali – Piper longum, Maricha – Piper nigrum and leaves of bilva – Aegle marmelos along with the juice of sugar-cane, vidari – Pueraria tuberosa and Amalaki – Phyllanthus emblica for the cure of the diseases
7. The patient suffering from Kamala(Jaundice) may also take the paste of ½ Pala of Danti mixed with 1 pala jaggery along with cold water and
8. The patient suffering from Kamala (jaundice) may also take Trivrt – Operculina turpethum along with the decoction of Triphala [551/2- ½ 60]

Vishaladi Phanta

1 Karsha of each of
Vishala – Citrulus colocynthis
Haritaki – Terminalia chebula,
Bibhitaka – Terminalia bellerica,
Amalaki – Phyllanthus emblica,
Musta – Cyperus rotundus,
Kustha – Sausserea lappa,
Devadaru – Cedrus deodara and
Kalingaka,
½ Karsha – 12 g of
Ativisa – Aconitum heterophyllum,
2 Karsha – 12 gs of Madhurasa (Murva) is made to a paste by triturating with luke-warm water and strained.
After taking this infusion, the patient is given honey.
This phanta cures-
Kasa – bronchitis
Shvasa – Asthma
Jwara – fever
Daha – burning sensation
Pandu-Roga – Anemone
Aruchi – anorexia,
Gulma – Phantom tumor
Anaha – constipation
Amavata – rheumatism and
Rakta-Pitta – a diseases characterized by bleeding from different parts of the body [60 ½- ½ 63]

Other medicines

Older recipes which are useful for these ailments are as follows:
1. The patient suffering from Kamala (jaundice) should take in the morning the decoction of Triphala, Guduchi – Tinospora cordifolia, Devadaru – Cedrus deodara or Nimba – Azadirachta indica after cooling and adding honey
2. The patient suffering from Pandu-Roga may take milk or urine of cow or buffalo for 1 fortnight.
3. The patient suffering from Pandu-Roga take the decoction of Triphala along with cow’s urine for 1 week
4. The tender branches of Matulunga – Citrus medica is set on fire, and then immersed in cow’s urine. Thereafter, a paste is prepared of these tender branches and strained. The liquid, thus obtained, is used by a patient suffering from Anaemia and oedema.
5. Suvarna- Ksiri, Syama- Trivrt – Operculina turpethum, Bhadra-daru and Nagaru is triturated by adding 1 Anjali of cow’s urine. The above mentioned drugs may also be boiled with milk. Intake of these potions causes downward movement (elimination) of Doshas (causing Pandu)
6. Alternatively, the patient [ suffering from Pandu- Roga] should take a course (for 7 days) of Haritaki – Terminalia chebula along with cow’s urine, and after the digestion of the recipe, he should take food with milk or sweetened meat soup and
7. The powder (bhasma) of iron is impregnated with cow’s urine for 7 nights. The physician should administer this potion along with milk the alleviation of Pandu- Roga (Anaemia). 63 1/3- 69]

Navayasa Churna

Navayas Churan:
1 part of each of the powders of
Sunthi – Zingiber officinale,
Pippali – Piper longum,
Maricha – Piper nigrum,
Haritaki – Terminalia chebula,
Bibhitaki – Terminalia bellerica,
Amalaki – Phyllanthus emblica,
Musta – Cyperus rotundus,
Vidanga – Embelia ribes and
Chitraka – Plumbago zeylanica and
9 parts of the powder (bhasma) of iron is mixed together.
Intake of this recipe along with honey and ghee cures
Pandu – Anaemia,
Hrud roga – heart diseases,
Kustha (obstinate skin diseases including leprosy),
Arshas – Piles and
Kamala -Jaundice
This recipe propounded by Krshnatreya is called Navayasa- curna
Thus, ends the description of Navayasa- curna [70- 71]

Read more about Navayas Churna uses, dose, side effects

Mandura Vataka

Two Recipes of Mandura Vataka
1 part of each of Jaggery, Sunthi – Zingiber officinale, Mandura and Taila 2 parts of Pippali – Piper longum is triturated [by adding water] and made to pills. This recipe is useful for patients suffering from Anemia.
2 Palas of each of
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum
Haritaki – Terminalia chebula
Bibhitaka – Terminalia bellerica
Amalaka – Phyllanthus emblica
Musta – Cyperus rotundus
Vidanga – Embelia ribes
Chavya – Piper retrofractum
Chitraka – Plumbago zeylanica
Bark of devadaru – Cedrus deodara is made to powders separately.
The powder of 56 Palas of Mandura, which is dark in colour like collyrium is cooked by adding 8 times of cow’s urine, and to this, the powders of the above mentioned drugs is added.
From out of this (Paste), Vatakas (large size Pills) of shape of the fruit of Udumbara – Ficus racemosa is prepared.
This is taken by the patient in appropriate dose depending upon his Agni (powder of digestion and metabolism) along with butter-milk. After its digestion, the patient should takes wholesome food
These pills are called mandura-Vataka and these are the life givers for the patient suffering from Anaemia.
In addition, these pills cure
Kustha (obstinate skin diseases including leprosy),
Ajirna – indigestion,
Shotha – oedema,
Ura-stambha (stiffening of the things),
Diseases caused by the aggravation of Kapha,
Arshas – piles,
Kamala – Jaundice,
Meha – urinary tract disorders, diabetes (obstinate urinary diseases including diabetes) and
Pliha – splenic diseases.
Thus ends the description of (2 types of) Manduravataka [72-77]

Tapyadi Yoga

5 palas of each of Tapya (svarna-Maksika), Silajatu, silver (bhasma or powder) and Mandura is added with (the powders of) 1 Pala of each of
Chitraka – Plumbago zeylanica
Haritaki – Terminalia chebula
Bhibhitaka – Terminalia bellerica
Amalaki – Phyllanthus emblica
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum and
Vidanga – Embelia ribes and
8 Palas of sugar
This recipe is taken habitually by the patient suffering from Pandu in the dose of 1 Karsha – 12 g along with adequate quantity of honey.
After the digestion of this potion, the patient should take wholesome food in small quantity. He should avoid taking Kulattha (horsegram), Kakamachi – Solanum nigrum etc. and the meat of Kapota (pigeon). [78 ½ – 80]

Yogaraja

1 part each of
Haritaki – Terminalia chebula
Bibhitaka –Terminalia bellerica,
Amalaki – Phyllanthus emblica
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum
Root of Chitraka – Plumbago zeylanica and
Vidanga – Embelia ribes
5 parts of each of
Shilajatu,
Raupya Mala (silver rust),
Purified Maksika, and
Powder (Bhasma) of iron, and
8 parts of sugar is made to a fine powder.
This potion is mixed with adequate quantity of honey and kept in a clam iron jar.
This recipe is taken by the patient in a quantity equal to a fruit of udumbara – Ficus racemosa according to his power of digestion every day.
After its digestion, he is given the desired food excluding kulattha, Kakamaci and meat of Kapota.
This ambrosia- like recipe is called Yogaraja.
It is an excellent rejuvenative recipe which cures all diseases and bestows auspiciousness.
It specially cures
Pandu – Anaemia,
Visham – poisoning,
Kasa – bronchitis,
Yakshma – tuberculous,
Visama Jwara – fever (irregular fever),
Kustha – obstinate skin diseases including leprosy),
Ajirna – indigestion,
Meha – obstinate urinary disorders including diabetes),
Kshya – consumption,
Shvasa – Asthma,
Aruchi – anorexia,
Apasmara – epilepsy,
Kamala – Jaundice and
Arshas – piles.
Thus ends the description of Yogaraja. [80 ½- ½ 87]

Shilajatu Vataka

8 Palas of Shilajatu is impregnated for 10, 20 or 30 days with the decoction of the fruit of Kutaja – Hollarhena dysentrica, Haritaki – Terminalia chebula, Bibhitaki – Terminalia Bellerica, Amalaki – Phyllanthus emblica, Nimba – Azadirachta indica, Patola- Trichosanthes dioica , Ghana, and Nagara – Zingiber officinale.
To this Silajatu, 8 Palas of sugar, and the powder of 1 Pala of each of Tvak-Ksiri (Vamsa-Lochana), Pippali – Piper longum, Dhatri and Karkata- Srngi
½ Pala of each of the fruit and root of Nidigdhika and adequate quantity of the powder of tvak, Ela, and Patra is added by adding 3 Palas of honey to this powder, Vatakas or Gudas (large size pills) of 1 Aksha each is prepared.
Having taken these pills on empty stomach or after taking food, the patient is made to drink the juice of Dadima – punica granatum, milk, soup of the meat of birds, water, alcohol or Asava (medicated wine).
It cures
Pandu – Anaemia,
Kustha – obstinate skin diseases including leprosy
Jwara – fever
Pliha – splenic disorders
Tamaka type of Asthma
Arshas – piles
Bhagandara – fistula-in-ano,
Puti – purified ulcers,
Hrut roga – heart diseases,
Shukra, mutra, agni dosha – diseases of semen, urine and agni (powder of digestion),
Sosha – consumption,
Gara – poisoning,
Udara – obstinate abdominal diseases including ascites
Shvasa – bronchitis,
Asrgdara – Menorrhagia
Rakta-Pitta (a diseases characterized by bleeding from different parts of the body),
Shotha — oedema,
Gulma – abdominal tumor, distension (phantom tumor),
Gala rogas – diseases of the throat, and all types of ulcer
It cures all types of diseases, and bestows auspiciousness.
Thus ends the description of Silajatu- Vataka. [87 ½ – ½ 93]

Punarnava Mandura

The powder of 1 Pala each of
Punarnava – Boerhavia diffusa
Trivrt – Operculina turpethum
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha— Piper nigrum
Vidanga – Embelia ribes
Devadaru – Cedrus deodara
Chitraka – Plumbago zeylanica
Kustha – Sausserea lappa
Haridra – Berberis aristata
Daru- Haridra – Berberis aristata
Haritaki – Terminalia chebula
Bibhitaki – Terminalia bellerica
Amalaki – Phyllanthus emblica
Danti – Baliospermum montanum
Chavya – Piper retrofractum
Kalingaka
Pippali – Piper longum
Pippali Mula – Piper longumand
Musta – Cyperus rotundus and
40 Palas of Mandura (rest of iron) is cooked in 2 Adhakas of cow’s urine. From out of this, Mandura cures
Pandu – Anaemia,
Pliha – splenic disorders,
Arshas – piles,
Visama- Jwara (irregular fever),
Shotha – oedema
Grahani- Dosha – sprue syndrome
Kustha – obstinate skin diseases including leprosy and parasitic infestation.
Thus, ends the description of Punarnava- Mandura. [93 ½- 96]

Read more about Punarnava mandura uses, dose, side effects

Darvyadi Leha

The powder of the
Bark of Daruharidra – Berberis aristata,
Haritaki – Terminalia chebula,
Bibhitaka – Terminalia bellerica,
Amalaki – Phyllanthus emblica
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum
Vidanga and
Iron (Bhasma) is mixed with ghee and honey, and taken as linctus by the patients suffering from Jaundice Anaemia. [97]

Two Recipes
The patient suffering from Jaundice should take the powder of 1 part of each of iron (bhasma), Haridra along with honey and ghee. He may also take the linctus of the powder of Abhaya prepared by mixing with Jaggery and honey [98]

Dhatryavaleha

The powder of 2 Palas of each of
Vamsa-lochana,
Sunthi and
Madhu-yasti
1 Prastha (768 g)of each
Pippali – Piper longum – long pepper and
Draksa – raisins – Vitis vinfera, and
½ a tula of crystal sugar is added with 1 drona of the juice of Amalaki- fruit – Phyllanthus emblica, and cooked till the whole thing becomes a linctuses.
After it is cooled down, 1 Prastha of honey is added.
Intake of 1 Panitala of this linctuses cures
Kamala – Jaundice,
Diseases caused by Pitta,
Pandu – Anaemia,
Kasa – bronchitis and
Halimaka (a type of Jaundice)
Thus, ends the description of Dhatryavaleha. [100 – ½ 102]

Mandura Vataka (another recipe)

1 part of each of
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum
Haritaki – Terminalia chebula
Bibhitaka – Terminalia bellerica
Amalaki – Phyllanthus emblica
Chavya – Piper retrofractum
Chitraka – Plumbago zeylanica
Devadaru – Cedrus deodara
Vidanga – Embelia ribes
Musta – Cyperus rotundus and
Vatsaka (Kustaja) is made to a powder.
To this equal quantity (12 parts) of the Powder of Mandura (rest of iron) is added.
These powders are boiled by adding 8 times of cow’s urine over mild fire. When the recipe becomes cool, pills of 1 Aksha each is prepared and taken according to the powder of digestion.
This cure:
Pliha – splenic diseases,
Pandu – Anaemia
Grahani (sprue syndrome) and
Arshas – piles.
While taking these pills, the patient should take butter- milk and Vatya (a preparation of roasted barley).
These, ends the description of Mandura- vataka [102 ½- ½ 105]

Gaudarista

Manjistha—Rubia cordifolia
Haridra – Berberis aristata
Draksa – Vitis vinfera
Roots of Bala – Abution indicum
Powder (bhasma) of iron and
Lodhra – Symplocos racemosa is (added with jaggery and) processed according to the method prescribed for Arista (a type of medicated wine).
This is called Gaudarista which is useful for the patients suffering from Anaemia [105 ½- ½ 106]
Thus ends the description of Gaudarista

Bijakarista

16 Palas of Bijaka (Asana)
20 of Triphala,
5 Palas of Draksha – Vitis vinfera and
7 Palas of Laksha is added with 1 Drona of water, and boiled till 1/4th of water remains.
Water is then be taken out by straining.
To this, 1 Tula of sugar and 1 Prastha of honey, and 1 Pala of the powder of each of
Sunthi – Zingiber officinale,
Pippali – Piper longum
Marica,
Vyaghra Nakha (a type of Nakhi),
Usira,
Karamuka,
Elavaluka,
Madhuka – Madhuca longifolia and
Kustha – Sausserea lappa is added.
The potion is stored in a jar smeared with ghee, and kept inside a heap of barely for 10 nights during summer, and for 20 nights in winter.
Intake of this potion cures
Grahani (sprue syndrome),
Pandu – Anaemia,
Arshas – piles,
Shotha – oedema,
Gulma (phantom tutor),
Mutra krcchra- dysuria, stone in urinary tract,
Meha – obstinate urinary disorders including diabetes
Kamala – jaundice and
Sannipata – diseases caused by the simultaneous vitiation of all the 3 Doshas
This is called bijakarista and it was propounded by Atreya. [106 ½ -111 ½]

Dhatryarista

1000 fruits of Amalaki are crushed and their juice is extracted.
To this, 1/8th the quantity of honey,
½ kudava of Pippali – Piper longum, and
½ Tula of sugar is added it is then kept in a ghee-smeared earthen jar for 1 fortnight.
It is taken in appropriate dose in the morning.
After the recipe is digested, the patient should take wholesome food in small quantity.
This Arista (medicated wine) cures
Kamala – jaundice,
Pandu – Anaemia,
Hrud roga – heart diseases,
Vata-rakta – gout,
Vishama jwara – irregular fever),
Kasa – bronchitis,
Hikka – hiccup,
Aruchi – anorexia and
Shvasa – Asthma.
Thus ends the description of Dhatryrista [111 ½- 114 ½]

Drinks
Water boiled with the drugs belonging to Sthiradi group (Sala-Parni, etc vide Sutrasthana 4:17) is useful for drinking, and for the preparation of food for the patient suffering from Anaemia.
For the patient of jaundice, the juice of Draksha – Vitis vinfera and Amalaki – Phyllanthus emblica is useful (as drink and for the preparation of food).

General line of treatment

The above mentioned recipes are described by the great sage (Punarvasu Atreya) for the cure of Pandu Roga (Anaemia).
The physician should make appropriate changes (Permutations and combinations) depending upon the strength of Doshas in the patient.
For Vatika type of Pandu the therapy is dominated by unctuous drugs (oil, ghee etc)
For Paittika type of Pandu, is dominated by bitter and cooling medicines.
For Kaphaja type of Pandu, the therapy is dominated by pungent, bitter and hot drugs.
For Sannipatika type of Pandu all the above mentioned ingredients is combined. [115 ½- 117 ½]

Mrud Bhakshanaja Pandu treatment

Treatment of Mrid- Bhaksanaja- Pandu:
The physician, well versed in therapeutics, should give sharp (strong) elimination therapy, keeping in view the strength or otherwise of the patient, in order to remove the swallowed mud from his body.
After the body is cleansed, the patient is given different types of medicated ghee for the promotion of his strength. [117 ½- 118]

Vyoshadya Ghruta

Ghee boiled with
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum
Bilva – Aegle marmelos
Haridra
Daru- Haridra – Berberis aristata
Haritaki – Terminalia chebula
Bibhitaka – Terminalia bellerica
Amalaki – Phyllanthus emblica
Sveta- Punarnava –
Rakta- Punarnava
Musta – Cyperus rotundus
Powder (bhasma) of Iron,
Patha – Cissampelos pariera
Vidanga – Embelia ribes
Deva-daru – Cedrus deodara
Vrscikali
Bhargi and
Milk is appropriately taken by the patient who suffers from Anaemia because of swallowing clay (mud)
Similarly, ghee boiled with
Kesara,
Yasti- Madhu – Liquorice
Pippali – Piper longum
Ksara – alkali preparation and
Sadvala (Durva – Cynodon dactylon (Linn.) Pers is given to the patient suffering from Mrd- Bhaksanaja- Pandu. [119- ½ 121]

Recipe for Causing Aversion for Mud

If the patient is unable to give up his clay-swallowing habits he is given clay impregnated with
Vidanga – Embelia ribes
Ela – Elattaria cardamum
Ativisa – Aconitum heterophyllum
Neem-leaf – Azadirachta indica
Patha – Cissampelos parriera
Vartaka,
Katu-rohini – Piccrrohiza kurroa
Kuthaja or
Murva – Marsedenia tenacissima with a view to creating aversion in him (for clay)
These drugs contract the adverse effects of clay Swallowing. [121 ½- 123]

Line of treatment of Mrud- Bhaksanaja- Pandu:
Depending upon the Doshas aggravated, different types of treatment is given to the patient suffering from Mrud Bhaksanaja- pandu (Anaemia caused by swallowing clay).
However, because of the specific nature of the causative factor the type of Anaemia needs special type of treatment. [123 ½ – 124 ½]

Shakhasrita Kamala

If a patient of jaundice voids stools having the colour of sesame paste – Tilapishtanibha Varchas, then it indicates the obstruction to the bile passage by Kapha.
Therefore, the Pitta (bile) of such a patient is eliminated by the administration of medicines which also balance Kapha.
Because of the excessive use of dry, cold and sweet ingredients, because of excessive exercise and because of the suppression of natural urges, Vata Dosha along with Kapha gets aggravated to cause displacement of Pitta.
Thus, the eyes, urine and skin of the patient become yellow in colour, and his stool becomes white in colour.
In addition, the patient suffers from
Atopa (tymphanitis),
Vistambha (constipation associated with flatulence) and
Heaviness in the cardiac region
Since the displaced Pitta gets located in the periphery (skin and Muscles), and there is reduction in the flow of Pitta (to the gastro-intestinal tract), the patient gradually suffers from weakness, Agnimandya (Suppression of the power of digestion weakness, Agnimandya, pain in the sides of the chest, hiccup, dyspnoea, anorexia and fever. [124 ½ – ½ 128]

Food for Sakhasrita- Kamala
The patient suffering from Shakhasrita- Kamala is given food along with the soup of the meat of peacock, partridge and cock sizzled with dry, sour and pungent articles, and vegetables soups of dry radish and Kulattha.
The patient is also given the juice of Matulunga – Citrus medica mixed with honey.
Pippali – Piper longum, Maricha – Piper nigrum and Sunthi – Zingiber officinale in order to bring the (diverged) Pitta to its own course [128 ½- ½ 130]

Duration of the treatment
The treatment with pungent, sharp, hot saline and extremely sour drugs is continued till the stool of the patient acquires the color of pitta (yellow because of the presence of bile), and the vayu gets alleviated. When Pitta returns to its own habits, the stool gets colored with Pitta (bile), and the patient prescribed earlier for the treatment of Jaundice (kosthasritha Kamala) should be resumed. [130 ½ -1/2 132]

Halimaka Type of Jaundice

If the colour of the patient suffering from Pandu (Anaemia) because green, black or yellow, and he suffers from diminution of strength and enthusiasm, Tandra – Drowsiness, Agnimandya (Suppression of the power of digestion), Jwara – mild fever, lack of libido, malaise, Shvasa – dysponea, Trshuna – morbid thirst, Aruchi – anorexia and Bhrama – giddiness, the ailment is called Halimaka which is caused by the aggravation of Vayu and Pitta. [132 ½ – ½134]

Treatment of Halimaka
The patient suffering from Halimaka should take the recipe prepared of the ghee from buffalo milk by adding the juice of Guduchi – Tinospora cordifolia and Milk.
After he is oleated, the patient should take Trivrt – Operculina turpethum mixed with the juice of Amalaki – Phyllanthus emblica which causes purgation. Thereafter, he should take (food and drinks) which are dominated by sweet taste and are alleviators of pitta and Vayu.
He should take Draksavaleha described earlier. The recipe is described with the caption Dhatryavaleha and recipes of medicated ghee prepared by boiling with sweet medicines.
He should habitually resort to different types of Yapana- Basti (a type of medicated enema), Ksheera- Basthi and anuvasana- Basti (to be discussed in detail in Siddhi section).
He should also take different recipes of Arista (medicated wine) prepared of grape (Draksarista) for the promotion of the digestion Abhaya-leha(Agastya- haritaki) described in the chapter dealing with the treatment of Kasa or Bronchitis (wide Cikistsa 18: 57-62) may be taken by him.
Alternatively he may take Pippali – Piper longum, Madhuka – Madhuca longifolia and Bala—Abution indicum along with milk, depending upon the Doshas aggravated, and the strength of the patients. [134 ½- ½ 138]

Summary:
In this chapter, the following topics are described
1. 5 types of Pandu (Anaemia) along with etiology, signs and symptoms and treatment
2. 2 types of Kamala (Jaundice), and their curability as well as incurability
3. Different varieties (stages) of Kamala and
4. Halimaka which is a serious diseases along with its signs and symptoms, and treatment. [138 ½- 139]

Thus, ends the 16th chapter in Chikistha Sthana – treatment section, dealing with the treatment of Pandu Roga (Anaemia) in the work of Agnivesha which was redacted by Charaka and supplemented by Dridhabala.