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AnaemiaControl throughAyurvedaLooking forward for Healthy Society throughAyurveda MedicineOrganized byNational Ayurveda Research Institute for Vector Borne Diseases, Vijayawada(Central Council for Research in Ayurveda and Siddha, Dept. of AYUSH, Ministry ofHealth & Family Welfare, Govt. of India)In Association with - Dr. N. R. S. Govt. Ayurvedic College, VijayawadaDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

ైదుయ్లకు అనందనలోATechnoayurveda InternationalPresentationInAssociation withAyurmitraTechnoayurveda.wordpress.comNational Campaigns on Ksharasutra, Geriatric care,Anemia Control, Management of Chronic Diseasesand Mother & Child Health Care through Ayurveda atNRS Govt. Ayurveda College, Vijayawadaon 27-03-2011

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNecessity Discussion Focus / Incidence Pandu DefinitionDiscussion on Management Conclusion1• Pandu vis-à-vis Anaemia is a problem of public healthsignificance• Anaemia is the most prevalent nutrition problem• Common susceptible are – Children, Women• It not only impacts the body but also to the occupation asfatigue, inattention, impaired motor coordination, etc. arecommon symptoms• Anemia is on the rise in India, says NFHS report 1• The healing powers of Ayurveda, the age-old practice ofgoing to the root of any disease without causing any sideeffects 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 AyurvedaIntroduction About Pandu Treatment PrinciplesNecessity Discussion Focus / Incidence Pandu DefinitionDiscussion on Management Conclusion2• Prevalence of anaemia in pregnant women (haemoglobin

Introduction About Pandu Treatment PrinciplesAnaemia Control through AyurvedaNecessity Discussion Focus / Incidence Pandu DefinitionDiscussion on Management Conclusion• Pandu: Any condition presenting the symptoms of Palpitation,edematous Eyes, Sweat-lessens, Fatigue by vitiating theRasavaha Srotas (Heart & 10 Dhamani) with manifestation ofrough & “Whitish Yellow” colour 1 (pallor Yellow) Skin is pandu.• Anaemia: Any condition in which the number of RBC/cu mm, theamount of hemoglobin in 100 ml of blood, and the volume ofpacked red blood cells per 100 ml of blood are less than normal;– clinically, generally pertaining to the concentration of oxygentransportingmaterial in a designated volume of blood, incontrast to total quantities as in oligocythemia,oligochromemia, and oligemia.– Anemia is frequently manifested by pallor of the skin andmucous membranes, shortness of breath, palpitations of theheart, soft systolic murmurs, lethargy, and fatigability 2 .31- Sharngadhara samhita, Pra.Knanda, 7-19/ Adhamalla, AH Chi 13/32 –Stedman’s Electronic Medical dictionary, 1998, Novell Reference engine softwareDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment Principles Discussion on Management Conclusion4Nidana – Aetiology Classification Pandu Symptoms Pandu-Complications Samprapti• Pandu is a Pitta predominant Plasma bound (RasaPradooshaja) 1 deficiency disorder, manifests at Skin &Blood (Rakta) by impaired nourishment• The common routes of manifestation of the Panduincludes –– Dietetic Deficiencies (iron deficiency)– Over Nourishment 2 (ingestion of High caloric / fat food)– High utilization of Rasa 3 (excessive Sex, Exercise, daysleep)– Diseases where Blood is lost (Nidanarthakara Vyadhi –viz. Piles, TB, Injury)– Others – such as wrong schedule of Snehapana &Panchakarma 41- Cha. Su 23/5-7; 2 –Cha Su 28/9-10; 3- Cha Chi 16/6-10; 3 – Cha su 13/21Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu Symptoms• Apathya Nimitta– Excessive Use of• Salt• Sour• Alcohol• Fats• Hot / Pungent• Masha (Blackgram)• Til (sesame)• Asatmya (Allergic)– Deficient use of• Iron• CaloriesDiscussion on Management ConclusionPandu-Complications Samprapti• Anya Nimitta– Exercise (Vyayama)– Intercourse (Vyavaya)– Suppression of urges(Vegarodha)– Mud eating (Mrid bhakshana)– Day sleep when the food isnot digested– Seasonal influences– Improper Panchakarma– Krimi– Raktapitta, Raktatisara,Raktarshas, Rakta Pradara,Rajayakshma,– Injury5Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu SymptomsAbhyantaKaranaApathyanimittajaPanduNijaSantarpana –Hyper NourishedApatarpana –Under nourishedBahyaKaranaMritbakshana– Mud eatingVatajaPittajaKaphajaTridoshajaDiscussion on Management ConclusionPandu-Complications SampraptiAbhighata- InjuryBleedingby InjuryBleedingby wormsBleedingby DiseaseThere are several types ofanaemia fromcontemporary scienceand these are:• Aplastic Anemia• Iron Deficiency(Normolytic) Anemia• Folic Acid DeficiencyAnaemia• Pernicious Anaemia• Fanconi Anemia• Sickle Cell Anemia• Sideroblastic Anemia• Thalassemia• Hemolytic Anemia• Hemoglobin C Disease• G6PD (Glucose-6-PhosphateDehydrogenase)Deficiency Anemia• Polycythemia Vera6Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu SymptomsPandu Pre-diseaseSymptoms Indigestion(Avipaka) Palpitation (HritSpandana) Fatigue (Ayaasam) Dryness of Skin(Rookshatwam) Pallor Skin (PanduTwacham) Decreased sweating(Aswedam) Oedematous Eye(Akshigola Sodha)Discussion on Management ConclusionPandu-Complications SampraptiThe signs of anaemiaor the symptoms ofanaemia are:- Extreme fatigue ortiredness- Short breath- Headaches- Depression- Weakness- Lack of Stamina- Dizziness- Impaired memory- Pale skin- Abnormally rapidheartbeat7Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Introduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu SymptomsAnaemia Control through AyurvedaDiscussion on Management ConclusionPandu-Complications SampraptiSymptom Vataja Pittaja Kaphaja Mrud-BhakshanaJanyaTwak Varna(Skin Colour)Twak Stiti(Skin status)Annavaha srotas(GIT)Krishna-Arunabha(Blakish Red)Peeta (yellowish) Shukla (whitish) *Rooksha (Dry) Daha (Burning) Sotha (Oedematous) Soonakshi Gandabhru (OedematousFace)Anaha (bloating) * Praseka (excesssalivation)General Toda (Body pains) Jwara (Fever) Alasya, Gourava(Lethargic)Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/Aruchi (anorexia)Krimikosts (worminfestation)Alasya, Gourava(malaise)Neurological Kanpa (tremor) * * *Endocrinal * Trushna(dehydration thirst)* *Psychosomatic * * Tandra (Stupor) Tandra (Stupor)Pranavaha(Respiratory)* * * Kasa (Cough), swasa(dyspnoea)Pureesha vaha * Bhinna vitka(Broken Stools)* Mucosal loose stools(sa-Kapha atisara)Tridoshaja Pandu will have mixed symptoms based upon the proportions of Tridosha impairment8

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu SymptomsDiscussion on Management ConclusionPandu-Complications Samprapti9SystemAnnavahasrotas(GIT)Pureeshavaha(Lower GIT)UdakavahaRasavahaGeneralSwedavahaRaktavahaComplicationArochaka (Anorexia)Hrillasa (salivation)Chardi (Vomiting)Baddhavit (Constipation)Haritavit (Green stool)Sakapha vit (Mucosal stool)Atisara (Diarrhoea)Trishna (Thirst)Soonam (edematous)Jwara (Fever)Kharibhoota (hyper dryness)Pandu Darshi (palor look)Chirakari (chronic)Atisweda (excessive sweat)KamalaCommon symptomsultimately getting are –Agni nashanamVarna NashanamTejo haratwamOjo haratwamVeerya haratwamBala NashanamIndriya bala nashanamDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu SymptomsDiscussion on Management ConclusionPandu-Complications Samprapti‣Formation and Function of Rakta: Rakta is nourished by the Rasa Sara bhagaprocessed by Pachakapitta and transforms as Rakta in the presence ofAmashayastha Ranjakapitta get RED coloured to make the Jeevana (oxygencarryingfunction) influenced by Sadhakapitta (Hridaya)10‣Hemoglobin 1 :‣The red, oxygen-carrying pigment in the red blood cells is hemoglobin, aprotein 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 haveabnormal O2 equilibriums. Others cause anemia.‣Eg: hemoglobin S polymerizes at low O2 tensions, and this causesthe red cells to become sickle-shaped, hemolyze, and form aggregatesthat block blood vessels. The result is the severe hemolytic anemiaknown as sickle cell anemia.‣Iron is essential for hemoglobin synthesis; if blood is lost from the body andthe iron deficiency is not corrected, iron deficiency anemia results.1) REVIEW OF MEDICAL PHYSIOLOGY - 21st Ed. (2003), Chapter 24Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu SymptomsDiscussion on Management ConclusionPandu-Complications Samprapti11‣In adults, about 85% of the erythropoietin comes from the kidneys and15% from the liver. In adults,‣Erythropoietin is produced by interstitial cells in the peritubular capillarybed of the kidneys and by perivenous hepatocytes in the liver.‣It is also produced in the brain, where it exerts a protective effect againstexcitotoxic damage triggered by hypoxia; and in the uterus and oviducts,where it is induced by estrogen and appears to mediate estrogen-dependentangiogenesis.‣Thus, the recombinant erythropoietin is of value in the treatment of theanemia 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 24Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesNidana – Aetiology Classification Pandu SymptomsAhara1ApathyaLavanaAmlaKsharaMadyaSnehaTilaMashaDoshajaPanduAmashaya(Stomach)Pachakapitta2Vata -DhatusaithilyataKapha -OjokshayaRakta -RaktalpatwamMamsa –Medolpatwam, Balavarna KshayaPrasada RasaKitta Rasa8 Tri-DoshaSthayi RasaAsthayi Rasa6Sweda,Mootra,PureeshaDiscussion on Management ConclusionPandu-Complications SampraptiRaktagni310 DhamaniKrimi, Disease,Injury, Bleeding, EtcPandu in Twak-mamsamadhyam AdhistanaPoorvaroopa(Hritspandanam,Roukshyam,Aswedam, Avipakam)Amashaya (Liver)RanjakapittaRaktaShareeraChankramana12Hridaya(Heart/Brain)SadhakapittaVyanavataNormal Functions (C Su24/4, S Sa 7/14)Jeevana, Ayush, bala, Varnaprasadanam, Sukha, Mamsapusti, Dhatu poorana, Sparsha547Mrit (Mud)Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment Principles Discussion on Management ConclusionSamprapti – Vighatana Management-schedule Non-Loha management Loha in PanduSiddhanta13• 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 – Doshaelimination is planned• Otherwise patient is selected for the palliative therapy• In common – Snehana – Vamana – Virechana – Shamanachikitsa are the patronized management methodsDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment Principles Discussion on Management ConclusionSamprapti – Vighatana Management-schedule Non-Loha management Loha in PanduSnehana14• 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 Nimittalooking 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 Pittapredominant• Ghrita is Ojo vardhaka – as the Pandu is with Ojo kshaya and roughskin• 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)Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment Principles Discussion on Management ConclusionSamprapti – Vighatana Management-schedule Non-Loha management Loha in PanduPanchakarma15• 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 - isgiven as to pacify the Pitta Dosha and Pittsthana udbhava vyadhi• Pathya Ghrita• Danti Ghrita• Tilvaka Ghrita• Trivrut Churna with Sharkara• Swadista virechana1 – 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 44/14Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesSamprapti – VighatanaDiscussion on Management ConclusionManagement-schedule Non-Loha management Loha in Pandu16• 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, etcDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment Principles Discussion on Management ConclusionSamprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu17• Yoga in Pandu» Churna – 10gms of Haritaki Churna with Ghee twicedaily 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 preparationsDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment Principles Discussion on Management ConclusionSamprapti – Vighatana Management-schedule Non-Loha management Loha in Pandu18• In case of palliative management Loha is said as themost 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)Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesAetiological-basis Deficiency-basis How to understand?Discussion on Management Conclusion19Dietetic Deficiencies Pandu issupplemented with suitableHigh utilization of Rasa requiressupplementation of nutrients and AgniregularazationOver Nourishment – or sneha ingestedPandu require elimination of the Doshaand there after regularization of the Dhatusequential processDiseases where Blood is lost – firstdisease is treated accordingly andnourishedOthers – such as Panchakarmavibhramsha developed Pandu is treated asVibhramsha chikitsaDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesDiscussion on Management ConclusionAetiological-basis Deficiency-basis How to understand?• Deficiencies as discussed –may Loha deficiency orPoorva dhatu (Rasa)deficiency– In case of Loha deficiency,supplementation will help– Rasa kshaya requires attention(Hridrava, Asahishnuta) – tounderstand the route cause andtreat accordingly– If Rakta Kshaya – (Injury, etc)require transfusion– Dosha kshaya / vruddhi aretreated accordinglyDr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/20

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesAetiological-basis Deficiency-basis How to understand?Discussion on Management Conclusion21• Santarpana i.e. fatty ingestion cause inactive bonemarrow that is infiltrated with fat is called yellowmarrow, which results in to Anaemia.• Overgrowth of bacteria (Mrit-bhakshana /Krimi) withinthe intestinal lumen can cause macrocytic anaemia. Thecause of the anaemia is mal-absorption (Srotas Block)of cyanocobalamin. Steatorrhea (Passage of fat in largeamounts in the feces) is due to excessive hydrolysis ofconjugated bile salts by the bacteria.• Iron (Loha) is essential for hemoglobin synthesis; ifblood is lost from the body and the iron deficiency isnot corrected, iron deficiency anemia results.• Excess production of bilirubin (Malaroopa Pitta) fromLiver leads to haemolytic anaemia.Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesAetiological-basis Deficiency-basis How to understand?Discussion on Management Conclusion• Acid-secreting cells of the stomach are damaged (Agnikshaya) in pernicious anaemia.• Parietal cells in the gastric mucosa (Amashaya samutha)secrete intrinsic factor, a 49-kDa glycoprotein that binds tocyanocobalamin (vitamin B12). Deficiency of it resultsAnaemia and deterioration of certain sensory pathways inthe CNS (Hridaya).• Rh incompatibility cause sensitization during pregnancyhaemolysis in the fetus develops anaemia.• Cobalt is part of the vitamin B12 molecule, and vitamin B12deficiency leads to megaloblastic anaemia.• Copper deficiency causes anaemia and changes inossification.22Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesAetiological-basis Deficiency-basis How to understand?Discussion on Management Conclusion• As we know today – the Blood and its development from foetus till tothe disease manifestation – Ayurveda refer the Blood and itsdevelopment, 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 DeficiencyAnaemia /Iron Deficiency (Normolytic) Anemia and itsmanagement• Why Ayurveda doesn’t speak the Pandu as Anuvamshika?• The shape based diseases/ conditions are not brought forward orare they with other nomenclature• Some conditions mimic Hemolytic Anemia – no recording of them• Probably the rest of the types discussed at present on contemporaryplatform are new observational developments and /or we miss thatpart of curriculum in Ayurveda23Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through AyurvedaIntroduction About Pandu Treatment PrinciplesDiscussion on Management Conclusion24• Even though many programs are offered by theGovt., why the Health Care systems are not up tothe mark is valuable question• Pandu – is studied in Ayurveda and offer amanagement through natural adaptations anddietetics –• Pandu susceptible Indian public are deviating themselves with life style and Junk food• At this juncture awareness programs even thoughreach the people – will not be followed by them - asthe demand is a quick relief with out changing theirhabits and attitudes• May be one day – the ultimate treatment for theAnaemia becomes “Blood Transfusion”, whereBlood is manufactured in the “Farm House”Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com/

Anaemia Control through Ayurvedatechnoayurveda@gmail.comTHANK YOUDr. K. Shiva Rama Prasad It’sOf Technoayurveda . . . technoayurveda.wordpress.comInternationalPresentationDr. K. Shiva Rama Prasad, PG Professor & Head, Panchakarma, SJG Ayu Med College, Koppal, Karnataka