Pandu Roga: Causes, Pathophysiology, Symptoms, Treatment

Article by Dr Raghuram Y.S. MD(Ayu)
Pandu Roga is generally considered as anemia as per Ayurveda.

When the pitta predominant doshas get aggravated in the tissues, the tissues undergo inflammation and get weak and lax. Heaviness also develops in the tissues of the body. This pathological process leads to deterioration of varna (colour), bala (strength and immunity), sneha (unctuousness of the body, the protective fat buffer) and other qualities of ojas (ojas is the essence of all the tissues and hence represents immunity).

The qualities of ojas go on deteriorating due to the complicated amalgamation of doshas and tissues (dhatus) in a disease complex. The person in whom this pathology sets in will be left out with less blood tissue in the body (anaemia), less fat (less insulation and protection to the body), less tissue essence and will suffer from weakness of the sense organs. The person ultimately gets vaivarnya (discoloured, mainly pallor) and such a condition is called Pandu Roga.-Cha. Chi. 16

Causes, pathogenesis

Causes and pathogenesis of Pandu Roga
Kshaara amla lavana ati ushna viruddha asaatmya bhojanaat
Nishpaava maasha pinyaaka tila taila nishevanaat
Vidagdhe anne diva swapnaad vyaayaamaat maithunaat tathaa
Pratikarma rutu vaishamyaat vegaanaam cha vidhaaranat
Kaama chintaa bhaya krodha shoka upahata chetasaha
Samudeernam yadaa pittam hrudayae samanvitam
Vaayunaa balinaa kshiptam sampraapya dhamaneehi dasha
Prapanne kevalam deham twak maamsaantara samaashritam
Pradooshya kapha vaata asruk twak maamsaani karoti tat
Paandu haaridra haritaan varnaan bahu vidhaam twachi
Sa paandu roga ityuktaha……… (Ref – Charaka Chikitsa 16/7-11)

Below mentioned are the causative factors of Pandu Roga –

• Kshaara – excessive consumption of alkalis
• Amla – excessive consumption of sour things
• Lavana – excessive consumption of salt or salty stuff
• Ati ushna – excessive consumption of hot substances / foods
• Viruddha ahara – mutually incompatible foods
• Asaatmya aahara – incompatible foods
• Nishpaava – Flat bean
• Maasha – black grams
• Pinyaka – paste of sesame
• Tila taila – sesame oil
• Vidagdha anna – corrosive foods
• Diwa swapna – sleeping during day time
• Vyaayaam – excessive physical exercise
• Maithuna – excessive indulgence in sex
• Pratikarma – doing any activities out of proportions
• Rutu vaishamya – seasonal incompatibility
• Vega dhaaranam – forcible suppression of natural body urges / reflexes
• Kaama – keeping attached to things
• Chinta upahata cheatas – mind afflicted by worries
• Bhaya upahata cheatas – mind afflicted by fear, panic,
• Krodha upahata cheatas – mind afflicted by anger
• Shoka upahata cheatas – mind afflicted by grief

Due to the above said factors, the pitta located in the Hrudaya (Sadhaka) gets vitiated. This pitt which has got aggravated is thrown into the circulation through the 10 dhamanis (main arteries) by the vitiated vata. This pitta being propelled by vata reaches all the corners of the body. It finally gets lodged between skin and muscles and further contaminates kapha, vata, rakta (blood), twacha (skin) and mamsa (muscles). The pitta imparts turmeric, pale (earthen) and green colours on the skin and causes pandu roga.

The above said aetiological factors are those which cause vitiation of pitta, which leads to the manifestation of inflammation in all parts of the body which come into contact with the vitiated pitta in circulation. The immunity deteriorates henceforth and causes autoimmune response. Since these causes afflicts the liver mainly and damage it, the inflammatory process first begins in the liver causing autoimmune hepatitis. Thus it can be said that the causes and pathogenesis of pandu roga and the symptoms (mentioned ahead) point towards autoimmune hepatitis or an autoimmune inflammatory process taking place in the liver, anaemia and jaundice being the chief by-products and chief manifestations of this process.

Symptoms

Symptoms of Pandu Roga
Sambhoote asmin bhavet sarvaM karna kshwedee hata analaha
Durbalaha sadano anna dwit shrama bhrama nipeeditaha
Gaatra shoola jwara shwaasa gourava aruchimaan naraha
Mruditaihi iva gaatraihi cha peedita unmathitaihi iva
Shoona akshi kooto haritaha sheerna lomaa hata prabhaha
Kopanaha shishira dweshee nidraaluhu shteevano alpa vaak
Pindika udweshtana kati ooru paada ruk sadanaani cha
Bhavanti aarohana aayasaihi visheshaha cha asya vakshyate (Ref – Charaka Chikitsa 16/13-16)

• Karna kshweda – sounds in the ears, tinnitus
• Hata analaha – low metabolism, indigestion
• Durbala – weakness, fatigue
• Sadana – laxity of the body, lethargy
• Anna dwesha – aversion towards the food
• Shrama – tiredness
• Bhrama – giddiness
• Gaatra shula – body pains
• Jwara – fever
• Shwasa – dyspnoea, shortness of breath
• Gourava – heaviness of the body
• Aruchi – tastelessness
• Mruditaihi iva gaatra – the patient feels as if he has been beaten up
• Peedita – feels as if the body has been compressed
• Unmathita – feeling as if the body has been churned
• Shuna akshi kuta – swelling around the eye sockets (orbit)
• Sheerna lomaha – falling or shedding of body hairs
• Hata prabhaha – lack lustre
• Kopanaha – feeling angry for simple causes, irritable nature
• Shishira dweshi – aversion towards cold
• Nidraaluhu – sleepiness
• Shteevana – excessive expectoration, spitting
• Alpa vaak – speaks less
• Pindika udweshtana – painful cramps in the calf muscles
• Kati ruk, sadana – low back pain and weakness
• Uru ruk, sadana – thigh pain, weakness
• Pada ruk, sadana – foot pain, weakness
• Arohana ayasa – feels breathless while climbing steps or going uphill.

Types

Types of Pandu Roga –

Pandu Roga again is of 5 types

Vataja Pandu Roga

Vataja Pandu Roga (Pandu Roga caused due to predominant vitiation of Vata) –

Causes – caused due to vata aggravating food and activities

The vitiated Vata produces black and pale / blackish brown or whitish yellow colour in the skin, dryness and redness in the body parts and organs, liver in this condition.

Symptoms –

• Angamarda – body pains
• Jwara – fever
• Toda – pricking pain
• Kampa – tremors
• Parshwa ruja – pain in flanks
• Shiro ruja – headache
• Varcha shosha – dryness of faeces
• Asya vairasya – manifestation of odd and abnormal tastes in the mouth
• Shopha swelling
• Anaha – distension of abdomen, flatulence
• Bala kshaya – deterioration of strength

Pittaja Pandu Roga

Causes – The pitta vitiating food and activities lead to excess vitiation and accumulation of pitta in the system which on contaminating rakta etc tissues causes pittaja pandu.

Symptoms –

• Peeta haritabha – body colour becomes yellow or green
• Jwara – fever
• Daha – burning sensation
• Trushna – thirst
• Murcha – fainting
• Pipasa – excessive thirst, depletion of water
• Peeta mutra – yellow discolouration of urine
• Peeta shakrut – yellow discolouration of faeces
• Swedana – excessive sweating
• Sheeta kama – liking towards cold things (food, comforts etc)
• Na annam abhinandati – dislike or aversion towards food
• Katuka asya – pungent taste in the mouth
• Ushna anupashaya – discomfort towards heat
• Amla anupashaya – discomfort towards sour foods
• Amla udgara – sour belching (due to incomplete digestion)
• Vidaha – severe burning sensation all through the body
• Dourgandhyam – foul smell from the body
• Bhinna varchastwam – diarrhoea
• Dourbalyam – weakness
• Tama – feeling of darkness before the eyes

Kaphaja Pandu Roga

Kaphaja Pandu Roga (Pandu Roga caused due to predominant vitiation of Kapha) –

Causes – The kapha vitiating food and activities lead to excess vitiation and accumulation of kapha in the system which on contaminating rakta etc tissues causes kaphaja pandu.

Symptoms –

• Gouravam – heaviness of the body
• Tandra – sleapiness
• Chardi – vomiting
• Shwetavabhasata – feeling as if the body has become white in colour
• Prasekam – excessive salivation, nausea
• Lomaharsham – horripulation
• Saadam – lethargy, slowing down of body activities, lack of interest in doing any type of activities
• Murcha – fainting, loss of consciousness
• Bhrama – giddiness
• Klama – fatigue
• Shwasam – dyspnoea, shortness of breath
• Alasya – lethargy, laziness
• Aruchi – tastelessness
• Vak graham – obstruction of speech
• Swara graham – obstruction of voice
• Shukla mutra – whitish discolouration of urine
• Shukla aksha – whitish discolouration of eyes
• Shukla varchastwam – whitish discolouration of stools
• Katu-ruksha-ushna-kamatam – liking towards pungent taste, dry and hot foods, drinks and comforts
• Shwayathu – swelling, inflammation
• Madhura asya – feeling of sweet taste in the mouth

Tridoshaja Pandu

Tridoshaja Pandu is caused by the simultaneous vitiation of all the 3 doshas due to the consumption or exposure of food and lifestyle activities which aggravate all the doshas. The symptoms of tridoshaja pandu will be a mixture of the symptoms said in the types of pandu manifested due to vitiation of individual doshas. This is said to be a complicated type of pandu, difficult to treat.

Mrittikajanya Pandu

This is a peculiar type of Pandu caused due to the consumption of mud.

Causes – Consumption of mud in excess leads to the vitiation of all the 3 doshas, which further vitiate the rakta etc tissues and cause Mrid bhakshanajanya Pandu or Mrittika janya Pandu. The mud doesn’t get digested by the metabolic fire. This mud which is not metabolised will fill up the channels of circulation in the body and deplete the cells and organs from nutrition, causes dryness and damage of the system.

Symptoms –

• Indriya bala nasha – destruction of strength of sense organs
• Tejo nasha – destruction of the heat element of the body or destruction of metabolic fire
• Veerya nasha – destruction of the potency of the body
• Ojo nasha – destruction of the essence of tissues
• Bala nasha – destruction of strength
• Varna nasha – destruction of colour
• Agni nashanam – destruction of digestion capacity
• Ganda shuna – swelling of cheeks
• Akshi shuna – swelling around eyes
• Bhru Shuna – swelling around the eyebrow
• Pada Shuna – swelling of the feet
• Nabhi Shuna – swelling of the navel region
• Mehana Shuna – swelling of penis
• Krimi koshta – worms in the gut
• Atisara – diarrhoea
• Sakapha mala – stools with phlegm
• Sa rakta mala – blood mixed stools

Signs of bad prognosis

Signs of bad prognosis in Pandu –

• Chirotpanna Pandu – chronic pandu
• Kharibhuta – deep rooted disease which has caused extreme dryness of all the tissues of the body
• Shuna, peetani pashyati – swelling all over the body due to chronicity and the patient sees everything around him or her yellow
• Baddha vit – constipation
• Alpa vit – less faeces
• Sakapha vit – stools with phlegm
• Harita atisara – diarrhoea with green coloured stools
• Shwetatwa – whiteness of the body due to excessive blood loss

Treatment principles

Principles of treatment for Pandu
Vamana (therapeutic emesis) and Virechana (therapeutic purgation) are ideal choices

Classical medicines and home remedies for Pandu

• Loha Bhasma (ash of iron) – with honey and ghee
• Shunti churna (ginger powder) with Loha Bhasma
• Loha bhasma with Gomutra (urine of cow)
• Powders of Ela (cardamom), Jeeraka (cumin seeds), Bhumyamalaki (Phyllanthus niruri) and Sita (sugar) – taken in equal quantities and mixed with ghee should be taken early in the morning
• Haridra churnam (turmeric powder) with curds early in the morning

Read related: Charaka Pandu Roga Chikitsa – 16th Chapter

Best medicines for Pandu and Shotha

• Guluchyadi Kashayam
• Drakshadi Kashayam
• Ardhavilwam Kashayam
• Patolakaturohinyadi Kashayam
• Punarnavadi Kashayam
• Mahatiktakam Kashayam
• Vasaguluchyadi Kashayam
• Lohasavam
• Lodhrasavam
• Drakshasavam
• Draksharishtam
• Rohitakarishtam
• Mridwikasavam
• Punarnavasavam
• Pippalyasavam
• Parthadyarishtam
• Dantyarishtam
• Chavikasavam
• Kumaryasavam
• Ayaskrity
• Loha bhasma
• Mandura Bhasma
• Punarnava Mandura
• Loha Mandura
• Shotari Mandura
• Madhu mandura
• Yakritpleehari Lauha
• Navayasa Lauham
• Svarnamakshika bhasma
• Rasasindhoora
• Mandura Vataka
• Arogyavardhini Vati
• Trailokyanatha Rasa
• Chandraprabha Vati
• Giloy Satwa
• Chinchadi leham
• Danti haritaki leham
• Drakshadi leham etc

Herbs beneficial for Pandu and Shotha:

• Bhumyamalaki – Phyllanthus niruri
• Amalaki – Emblica officinalis
• Sharapunka – Tephrosia purpurea
• Katuki – Picrorrhiza kurroa
• Punarnava – Boerhavia diffusa
• Kakamachi – Solanum nigrum
• Kalamegha – Andrographis paniculata
• Loha – Iron
• Kumari – Aloe vera
• Guduchi – Tinospora cordifolia
• Yashtimadhu – Glycyrrhiza glabra
• Haridra – Curcuma longa
• Bhringaraja – Eclipta alba
• Vasa – Adhatoda vasica
• Kiratatikta – Swertia chirayata
• Daruharidra – Berberis aristata etc.

Pathya – apathya according to Yogaratnkara:

Wholesome diet and habits :
Barley, wheat, rice prepared out of shali variety, soup prepared out of meat of animals living in desert-like land, greengram, Pigeon pea, masoor dal

Unwholesome diet and habits :
Heat of fire, sunlight, physical strain, Pitta aggravating food and drinks, sexual intercourse, anger, strenuous work etc.

Rasaushadhi

Loha Bhasma
Mandura Bhasma
Navayasa Lauha
Nisha Loha
Dhatri Loha
Vidangadi Lauh
Darvyadi Loh
Madhumalini Vasant
Punarnavadi Manduram
Tapyadi Lauh
Laghumalini Vasant

Anti-anemia decoctions

Effective anti-anemia decoctions from Sahasrayogam

1. Pandu Parvikardrakadi Kashayam

Ingredients –

• Parvika / Vacha – Acorus calamus
• Ardraka – Zingiber officinale / Ginger
• Kakamachi – Solanum nigrum
• Mandukaparni – Centella asiatica

Method of use:

1. Prepare the decoction with the above said ingredients and administer for internal use
2. Take the decoction with sesame seeds pounded in the juice of Bhringaraja i.e. Eclipta alba admixed with ash of iron

Indications – Pittaja Pandu – anemia caused by predominant vitiation of pitta.
Ref – Sahasrayogam, Parishishta Prakarana, 72

2. Vyoshadi Kashayam

Ingredients –

• Vyosha – powder of Piper longum, Piper nigrum & Zingiber officinale
• Ajamoda – Trachyspermum ammi
• Tavidvama / Punarnava – Boerhavia diffusa
• Karim / Ikshu mula – roots of Saccharum officinarum
• Chirimbu – rust of iron
• Haritaki – Terminalia chebula
• Bala mula – root of Sida cordifolia
• Puliyarambu / Chincha patra vrinta – petiole of leaf of Tamarindus indica or Vrikshamla – Garcinia indica
• Purana kitta – old slag / rust of iron
• Jambira – Citrus limon
• Nisa / Haridra – Curcuma longa
• Vajra lata / Asthi samhara – Cissus quadrangularis
• Tripadi / Hamsapadi – Adiantum philippense

Procedure of preparation and use –

• The above mentioned ingredients should be taken in earthenware.
• Equal quantity of water and buttermilk should be added to the vessel.
• The vessel should be kept on mild fire. Boil till the water portion is completely evaporated.
• Afterwards keep the vessel nearer to the fire so that the decoction should be always in lukewarm state.
• The decoction which has been prepared once shall be used for 7 days.
• The dose for internal consumption of this decoction is half pala i.e. 24 grams approximately.
• Replace the quantity of the decoction used every time with equal quantity of fresh buttermilk.

Indications – anemia
Ref – Sahasrayogam, Parishishta Prakarana, 73

3. Panduhara Kshaya

As the name itself indicates, these decoctions are good remedies for anemia. Three such ‘easy to prepare and consume decoctions’ have been enlisted in this context.

Ref – Sahasrayogam, Kashaya Prakarana, 46

a. Punarnavadi Kashayam

Ingredients –

• Punarnava – Boerhavia diffusa
• Nimba – Azadirachta indica / neem
• Patola – Trichosanthes dioica
• Shunti – Zingiber officinale
• Tikta / Katukarohini – Picrorhiza kurrooa
• Amruta / Guduchi – Tinospora cordifolia
• Darvi / Daruharidra – Berberis aristata
• Haritaki – Terminalia chebula

Indications – swelling all over the body, fever, cough, dyspnea, colic and complicated cases of anemia

b. Vasaguluchyadi Kashayam – Read more here

c. Tintrinyadi Kashayam

Ingredients:

• Tintrini taruna parna salaka – veins of tender leaves of Tamarandus indica
• Lohakitta / Mandura – slag / rust of iron
• Vijaya / Haritaki – Terminalia chebula
• Punarnava – Boerhavia diffusa
• Ikshu – Saccharum officinarum
• Bilwa – Aegle marmelos

Method of use – decoction should be prepared with the above mentioned herbs and administered along with jaggery.
Indications – treatment of anemia

Further contributed by Dr Shilpa and Dr Sudarshan
Yogas Mentioned in Sahasra Yoga Text book

Panduhara Kashaya
Tiktaka Ghrita
Mahatiktaka Ghrita
Panchatiktaka Guggulu Ghrita
Dhatryadi Ghrita
Dhanvantari Ghrita
Kalyanaka Ghrita
Maha kalyanaka Ghrita
Maha kushmanda Ghrita
Khandasama Choorna
Hapushadi Choorna
Patoladi Choorna
Hutabhungadi Choorna
Nimbadi Choorna
Hinguvachadi Choorna
Pathya Punarnavadi Choorna
Vyoshadi Choorna
Kayyonyadi Choorna
Nyaramooladi Choorna
Indrasani Choorna
Yogaraja Choorna
Karpooradi Choorna
Narasimha Choorna
Kalyana Kshara
Dasamoolarishta
Parpatadyarishta
Dhatryarishta
Pippalyasava
Usirasava
Lohasava
Patrangasava
Ellum Tippalyadi Lehyam
Chinchadi lehyam
Pulim Kuzhambu
Danti Haritakyavaleha
Bahusala Guda
Gandhaka Rasayana
Drakshadi Lehya
Gandira Rasayana
Pushparaga Lehya
Kaisora Guggulu
Mandoora Vataka
Lavangadyam Modakam
Loha Grudadi Gutika
Kittadi Gutika
Chandabhaskara Rasa
Neelakantha Rasa
Parvikardrakadi Kashaya
Vyoshadi Kashaya
Arukaladi Tailam
Dasa Swarasa Ghrita