Anaemia

Control through
Ayurveda
Looking forward for Healthy Society through
Ayurveda Medicine

Organized by
National Ayurveda Research Institute for Vector Borne Diseases, Vijayawada
(Central Council for Research in Ayurveda and Siddha, Dept. of AYUSH, Ministry of
Health & Family Welfare, Govt. of India)
In Association with - Dr. N. R. S. Govt. Ayurvedic College, Vijayawada

Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

 ద
ై ుయ్లకు అ నందనల ో
A
Technoayurveda International
Presentation

In
Association with
Ayurmitra
Technoayurveda.wordpress.com

National Campaigns on Ksharasutra, Geriatric care,

Anemia Control, Management of Chronic Diseases
and Mother & Child Health Care through Ayurveda at
NRS Govt. Ayurveda College, Vijayawada
on 27-03-2011
 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

1
Necessity Discussion Focus / Incidence Pandu Definition

• Pandu vis-à-vis Anaemia is a problem of public health

significance
• Anaemia is the most prevalent nutrition problem
• Common susceptible are – Children, Women
• It not only impacts the body but also to the occupation as
fatigue, inattention, impaired motor coordination, etc. are
common symptoms
• Anemia is on the rise in India, says NFHS report 1
• The healing powers of Ayurveda, the age-old practice of
going to the root of any disease without causing any side
effects seems to find favour with public.
1 - http://www.expressindia.com/latest-news/Anemia-is-on-the-rise-in-India-says-NFHS-report/336854/

Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Necessity Discussion Focus / Incidence Pandu Definition
2

• Prevalence of anaemia in pregnant women (haemoglobin <

11g per cent) of different parts of the country is in range of
33–89 per cent (Seshadri et al, 1994).1
• Data on prevalence of anaemia in adolescent girls is
limited. A study concluded on 1513 rural adolescent girls in
Gujarat indicated that 61 per cent of the girls were anaemic
with Hb < 12g per cent (Seshadri, 1998).
• Prevalence of anaemia in children in India is as high as 79
per cent 2
• These statements drags the attention of the Rural / Urban
physicians and declares the “National Health
Emergency”
1- Balendu Prakash, Seema Pandey and Shalini Singh, VCPC Research Foundation, Dehradun, Ayurvedic Preparation in the treatment of Nutritional Anaemia, NATIONAL CONFERENCE
ON OPPORTUNITIES AND CHALLENGES FOR PREVENTING MICRONUTRIENT MALNUTRITION THROUGH ICDS, pp 83-87
2 - http://www.expressindia.com/latest-news/Anemia-is-on-the-rise-in-India-says-NFHS-report/336854/

Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Necessity Discussion Focus / Incidence Pandu Definition
3
• Pandu: Any condition presenting the symptoms of Palpitation,
edematous Eyes, Sweat-lessens, Fatigue by vitiating the
Rasavaha Srotas (Heart & 10 Dhamani) with manifestation of
rough & “Whitish Yellow” colour 1 (pallor Yellow) Skin is pandu.
• Anaemia: Any condition in which the number of RBC/cu mm, the
amount of hemoglobin in 100 ml of blood, and the volume of
packed red blood cells per 100 ml of blood are less than normal;
– clinically, generally pertaining to the concentration of oxygen-
transporting material in a designated volume of blood, in
contrast to total quantities as in oligocythemia,
oligochromemia, and oligemia.
– Anemia is frequently manifested by pallor of the skin and
mucous membranes, shortness of breath, palpitations of the
heart, soft systolic murmurs, lethargy, and fatigability 2.

1- Sharngadhara samhita, Pra.Knanda, 7-19/ Adhamalla, AH Chi 13/3

2 –Stedman’s Electronic Medical dictionary, 1998, Novell Reference engine software

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti
4

• Pandu is a Pitta predominant Plasma bound (Rasa

Pradooshaja)1 deficiency disorder, manifests at Skin &
Blood (Rakta) by impaired nourishment
• The common routes of manifestation of the Pandu
includes –
– Dietetic Deficiencies (iron deficiency)
– Over Nourishment 2 (ingestion of High caloric / fat food)
– High utilization of Rasa 3 (excessive Sex, Exercise, day
sleep)
– Diseases where Blood is lost (Nidanarthakara Vyadhi –
viz. Piles, TB, Injury)
– Others – such as wrong schedule of Snehapana &
Panchakarma 4
1- Cha. Su 23/5-7; 2 –Cha Su 28/9-10; 3- Cha Chi 16/6-10; 3 – Cha su 13/21

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti
5

• Apathya Nimitta • Anya Nimitta

– Excessive Use of – Exercise (Vyayama)
• Salt – Intercourse (Vyavaya)
• Sour – Suppression of urges
• Alcohol (Vegarodha)
• Fats – Mud eating (Mrid bhakshana)
• Hot / Pungent – Day sleep when the food is
not digested
• Masha (Black
gram) – Seasonal influences
• Til (sesame) – Improper Panchakarma
• Asatmya (Allergic) – Krimi
– Raktapitta, Raktatisara,
– Deficient use of
Raktarshas, Rakta Pradara,
• Iron Rajayakshma,
• Calories – Injury

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti
6
Pandu
There are several types of
anaemia from
Abhyanta Bahya Abhighata contemporary science
Karana and these are:
Karana - Injury
• Aplastic Anemia
• Iron Deficiency
Mritbakshana (Normolytic) Anemia
Bleeding • Folic Acid Deficiency
Apathya – Mud eating by Injury
Nija Anaemia
nimittaja • Pernicious Anaemia
Vataja • Fanconi Anemia
Bleeding • Sickle Cell Anemia
Santarpana – by worms • Sideroblastic Anemia
Hyper Nourished Pittaja • Thalassemia
• Hemolytic Anemia
Bleeding • Hemoglobin C Disease
Apatarpana – Kaphaja by Disease • G6PD (Glucose-6-
Under nourished Phosphate
Tridoshaja Dehydrogenase)
Deficiency Anemia
• Polycythemia Vera

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti
7

Pandu Pre-disease
Symptoms The signs of anaemia
 Indigestion or the symptoms of
(Avipaka) anaemia are:
- Extreme fatigue or
 Palpitation (Hrit tiredness
Spandana) - Short breath
 Fatigue (Ayaasam) - Headaches
 Dryness of Skin - Depression
(Rookshatwam) - Weakness
 Pallor Skin (Pandu - Lack of Stamina
Twacham) - Dizziness
- Impaired memory
 Decreased sweating
- Pale skin
(Aswedam)
- Abnormally rapid
 Oedematous Eye heartbeat
(Akshigola Sodha)

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

8
Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti
Symptom Vataja Pittaja Kaphaja Mrud-Bhakshana
Janya
Twak Varna Krishna-Arunabha Peeta (yellowish) Shukla (whitish) *
(Skin Colour) (Blakish Red)
Twak Stiti Rooksha (Dry) Daha (Burning) Sotha (Oedematous) Soonakshi Ganda
(Skin status) bhru (Oedematous
Face)
Annavaha srotas Anaha (bloating) * Praseka (excess Aruchi (anorexia)
(GIT) salivation) Krimikosts (worm
infestation)
General Toda (Body pains) Jwara (Fever) Alasya, Gourava Alasya, Gourava
(Lethargic) (malaise)
Neurological Kanpa (tremor) * * *
Endocrinal * Trushna * *
(dehydration thirst)
Psychosomatic * * Tandra (Stupor) Tandra (Stupor)
Pranavaha * * * Kasa (Cough), swasa
(Respiratory) (dyspnoea)
Pureesha vaha * Bhinna vitka * Mucosal loose stools
(Broken Stools) (sa-Kapha atisara)
Tridoshaja Pandu will have mixed symptoms based upon the proportions of Tridosha impairment
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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

9
Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti

System Complication Common symptoms

Annavaha Arochaka (Anorexia) ultimately getting are –
srotas Hrillasa (salivation) Agni nashanam
(GIT) Chardi (Vomiting) Varna Nashanam
Pureeshavaha Baddhavit (Constipation)
Tejo haratwam
(Lower GIT) Haritavit (Green stool) Ojo haratwam
Sakapha vit (Mucosal stool) Veerya haratwam
Atisara (Diarrhoea)
Bala Nashanam
Udakavaha Trishna (Thirst) Indriya bala nashanam
Soonam (edematous)

Rasavaha Jwara (Fever)

General Kharibhoota (hyper dryness)

Pandu Darshi (palor look)
Chirakari (chronic)

Swedavaha Atisweda (excessive sweat)

Raktavaha Kamala

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti

10
Formation and Function of Rakta: Rakta is nourished by the Rasa Sara bhaga
processed by Pachakapitta and transforms as Rakta in the presence of
Amashayastha Ranjakapitta get RED coloured to make the Jeevana (oxygen-
carrying function) influenced by Sadhakapitta (Hridaya)
Hemoglobin 1:
The red, oxygen-carrying pigment in the red blood cells is hemoglobin, a
protein with a molecular weight of 64,450.
Hemoglobin is a globular molecule made up of 4 subunits
Many of the abnormal hemoglobins are harmless. However, some have
abnormal O2 equilibriums. Others cause anemia.
Eg: hemoglobin S polymerizes at low O2 tensions, and this causes
the red cells to become sickle-shaped, hemolyze, and form aggregates
that block blood vessels. The result is the severe hemolytic anemia
known as sickle cell anemia.
Iron is essential for hemoglobin synthesis; if blood is lost from the body and
the iron deficiency is not corrected, iron deficiency anemia results.
1) REVIEW OF MEDICAL PHYSIOLOGY - 21st Ed. (2003), Chapter 24

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti

11

In adults, about 85% of the erythropoietin comes from the kidneys and
15% from the liver. In adults,
Erythropoietin is produced by interstitial cells in the peritubular capillary
bed of the kidneys and by perivenous hepatocytes in the liver.
It is also produced in the brain, where it exerts a protective effect against
excitotoxic damage triggered by hypoxia; and in the uterus and oviducts,
where it is induced by estrogen and appears to mediate estrogen-dependent
angiogenesis.
Thus, the recombinant erythropoietin is of value in the treatment of the
anemia associated with renal failure;
Not only that the organs to value in this concern is – Stomach, Liver,
Kidney, uterus, Oviducts and Brain.

1) REVIEW OF MEDICAL PHYSIOLOGY - 21st Ed. (2003), Chapter 24

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti

Amashaya 12
2 Sthayi Rasa Amashaya (Liver)
(Stomach) Raktagni
Pachakapitta Ranjakapitta 4
Ahara
3
Prasada Rasa
1
Asthayi Rasa Rakta
Apathya 5 Hridaya
Kitta Rasa Sweda,
Lavana Mootra, 10 Dhamani (Heart/Brain)
Amla Vata - Pureesha Sadhakapitta
Dhatusaithilyata
Kshara Vyanavata
Madya Kapha - 6 Krimi, Disease, Shareera
Ojokshaya Injury, Bleeding, Etc Chankramana
Sneha
Rakta - 7
Tila
Raktalpatwam Pandu in Twak-mamsa Mrit (Mud)
Masha
madhyam Adhistana
Mamsa –
Medolpatwam, Bala Normal Functions (C Su24/4, S Sa 7/14)
varna Kshaya
Jeevana, Ayush, bala, Varna
Poorvaroopa prasadanam, Sukha, Mamsa
(Hritspandanam,
Doshaja Roukshyam, pusti, Dhatu poorana, Sparsha
Pandu 8 Tri-Dosha Aswedam, Avipakam)

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Samprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu
Siddhanta 13

• The treatment should be planned according to the aetiology

– At the level of Apatarpana / Santarpana / Apathya Ahara
– At the level of Bahya Karana – Mrit Bhakshana / Abhighata
– At the level of Nidanarthakara Roga
– At the level of Amashaya – Pachakapitta
– At the level of Liver - Raktagni / Bhutagni / Ranjakapitta
– At the level of Hridaya – Rasagni / Vyanavata /
Sadhakapitta
– At the level of Dosha
• When the dosha is strong or patient is capable – Dosha
elimination is planned
• Otherwise patient is selected for the palliative therapy
• In common – Snehana – Vamana – Virechana – Shamana
chikitsa are the patronized management methods

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Samprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu
Snehana 14

• As the aetiology could be – Santarpana (AHchi 16/1-Arunadatta)

• Clarify the unction in patient by skin examination
– If the patient is Apatarpana (malnourished) / Apathya Nimitta
looking at Dry-skin – Snehana is done
• Kalyanaka Ghrita
• Panchagavya Ghrita
• Mahatiktaka Ghrita
• Aragwadhadi Gana Ghrita
– Why the Ghrita?
• Ghrita is Pittaharam – as the Pandu is with vitiated Pitta
predominant
• Ghrita is Ojo vardhaka – as the Pandu is with Ojo kshaya and rough
skin
• Ghrita is Sneha vardhaka – as the Pandu is with rough/dry skin
• Sweda is contra indicated as the Pandu is Pittaja vyadhi
(AHS17/21-24)

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Samprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu
Panchakarma 15

• Anulomana 1 is indicated – understood as Urdhwa Anuloma (Vamana)

and Adho Anulomana (Virechana)
• Vamana – Urdhwa Anulomana
– Susruta contraindicated 2 – but Dalhana doesn’t accept it
– Why Vamana? – Amashaya samutha, Bahudosha, Rasa (Kapha)
predominant Pandu requires conditionally – when the patient is acceptable
– Vagbhta 3 - Charaka 4 - Susruta 6 indicated Teekshna Vamana
• Vamana with – Yastimadhu
• Vamana with – small quantity of Madana Yoga
• Virechana – Adho Anulomana
– Most common practice as there is no effort is exerted by the patient - is
given as to pacify the Pitta Dosha and Pittsthana udbhava vyadhi
• Pathya Ghrita
• Danti Ghrita
• Tilvaka Ghrita
• Trivrut Churna with Sharkara
• Swadista virechana

1 – Cha Chi 16/40 – Chakrapani, 2 – Su Chi 33/ 14 – Dalhana, 3 – AH Chi 16/5, 4 – Cha Chi 16/40 & Cha Chi 2/10 , 6- Su Ut 44/14

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Samprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu
16
• In case of palliative management Initially Kosta-
Shuddhi is done
– It means – Laghu Virechan with
• Swadista Virechana
• Rechakavati
• Offer Ghrita for attaining Strength in case of palliative management
– Amritadi Ghrata
– Vyoshadi Ghrita
– Nagakesharadi Ghrita
• Based upon the Dosha
– Vata – Sneha
– Pitta – Tikta Rasa, Sheeta veerya
– Kapha – Katu, Tikta rasa, Ushna veerya
– Sannipata – Vyamishra chikitsa
– Mrit Bhakshana – Vidanga, Patha, Chitramoola, etc

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Samprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu
17

• Yoga in Pandu
» Churna – 10gms of Haritaki Churna with Ghee twice
daily before food
– Other used herbs in Pandu are –
• Phalatrika, Amrita, Vasa, Tikta, Bhunimba, Nimba
– Asavaritsa –
• Lohasav, Ayaskriti, Bhringarajasav, Kumaryasav = 15-
20ml after food
– Rasa-Aushadhi –
• Kantavallabha ras, Pandu Panchanan Ras,
– Loha preparations

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion 18

Samprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu

• In case of palliative management Loha is said as the

most important (AH Ut 40/48)
– Different forms are used – viz. Loha, Mandura, Ayas, etc.
– Yogas with Loha –
• Navayasa churna
• Navayasa Loha
• Loha Bhasma – 300mg with Triphala churna
• Kantha loha bhasma
• Kanthavallabha rasa – 200mg BD with Honey
• Kasheesa bhasma 300mg with honey
• Swarnamakshika Bhasma 300mg with Gudodaka
• Tapyadi Loha 300mg with Honey
• Ayaskriti 15-20ml BD after food
• Lohasava 15-20ml BD after food
• Tryushanadi Madura
• Punarnavadi Mandura (takra anupana)

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

19
Aetiological-basis Deficiency-basis How to understand?

Dietetic Deficiencies Pandu is

supplemented with suitable
High utilization of Rasa requires
supplementation of nutrients and Agni
regularazation
Over Nourishment – or sneha ingested
Pandu require elimination of the Dosha
and there after regularization of the Dhatu
sequential process
Diseases where Blood is lost – first
disease is treated accordingly and
nourished
Others – such as Panchakarma
vibhramsha developed Pandu is treated as
Vibhramsha chikitsa
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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Aetiological-basis Deficiency-basis How to understand? 20

• Deficiencies as discussed –
may Loha deficiency or
Poorva dhatu (Rasa)
deficiency
– In case of Loha deficiency,
supplementation will help
– Rasa kshaya requires attention
(Hridrava, Asahishnuta) – to
understand the route cause and
treat accordingly
– If Rakta Kshaya – (Injury, etc)
require transfusion
– Dosha kshaya / vruddhi are
treated accordingly
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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Aetiological-basis Deficiency-basis How to understand? 21

• Santarpana i.e. fatty ingestion cause inactive bone

marrow that is infiltrated with fat is called yellow
marrow, which results in to Anaemia.
• Overgrowth of bacteria (Mrit-bhakshana /Krimi) within
the intestinal lumen can cause macrocytic anaemia. The
cause of the anaemia is mal-absorption (Srotas Block)
of cyanocobalamin. Steatorrhea (Passage of fat in large
amounts in the feces) is due to excessive hydrolysis of
conjugated bile salts by the bacteria.
• Iron (Loha) is essential for hemoglobin synthesis; if
blood is lost from the body and the iron deficiency is
not corrected, iron deficiency anemia results.
• Excess production of bilirubin (Malaroopa Pitta) from
Liver leads to haemolytic anaemia.

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Aetiological-basis Deficiency-basis How to understand? 22
• Acid-secreting cells of the stomach are damaged (Agni
kshaya) in pernicious anaemia.
• Parietal cells in the gastric mucosa (Amashaya samutha)
secrete intrinsic factor, a 49-kDa glycoprotein that binds to
cyanocobalamin (vitamin B12). Deficiency of it results
Anaemia and deterioration of certain sensory pathways in
the CNS (Hridaya).
• Rh incompatibility cause sensitization during pregnancy
haemolysis in the fetus develops anaemia.
• Cobalt is part of the vitamin B12 molecule, and vitamin B12
deficiency leads to megaloblastic anaemia.
• Copper deficiency causes anaemia and changes in
ossification.

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion

Aetiological-basis Deficiency-basis How to understand? 23
• As we know today – the Blood and its development from foetus till to
the disease manifestation – Ayurveda refer the Blood and its
development, even diseases born due to its deficiency or increase
• In this concern - Whether the Rakta vruddhi – is said as -
Polycythemia Vera
• Ayurveda much times speak about - Folic Acid Deficiency
Anaemia /Iron Deficiency (Normolytic) Anemia and its
management
• Why Ayurveda doesn’t speak the Pandu as Anuvamshika?
• The shape based diseases/ conditions are not brought forward or
are they with other nomenclature
• Some conditions mimic Hemolytic Anemia – no recording of them
• Probably the rest of the types discussed at present on contemporary
platform are new observational developments and /or we miss that
part of curriculum in Ayurveda

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 Anaemia Control through Ayurveda

Introduction About Pandu Treatment Principles Discussion on Management Conclusion 24

• Even though many programs are offered by the

Govt., why the Health Care systems are not up to
the mark is valuable question
• Pandu – is studied in Ayurveda and offer a
management through natural adaptations and
dietetics –
• Pandu susceptible Indian public are deviating them
selves with life style and Junk food
• At this juncture awareness programs even though
reach the people – will not be followed by them - as
the demand is a quick relief with out changing their
habits and attitudes
• May be one day – the ultimate treatment for the
Anaemia becomes “Blood Transfusion”, where
Blood is manufactured in the “Farm House”

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 Anaemia Control through Ayurveda

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Dr. K. Shiva Rama Prasad It’s
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OfTechnoayurveda International
Presentation
Dr. K. Shiva Rama Prasad, PG Professor & Head, Panchakarma, SJG Ayu Med College, Koppal, Karnataka