Sickle Cell Anaemia

Ayurvedic View of Janmabal Pravrut Pandu.
Sickle cell Anaemia..

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Ayurveda gives detail about genetic science. Indian scientists Charaka and Sushruta had described all these in their Samhita in B.C. period. Male and female are responsible for new born baby, which is the carrier of parents prakruti and this all thing have been done by vata. Vata promotes all other dosha, dhatu mala and so it is

equal to D.N.A.

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Above describe from Charaka indicate that Ayurveda have micro details of sarira,which was without microscopic observation.Like Puspak Vimana. They describe cells,sperma,ovum,fertilization,fellopian tube,syatem,organa and chromosome  before 5000 years ago in Sanskrit.

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JANMABAL PRAVRUT VYADHI

AETIOLOGY:-        1.GENETIC
                                2.FACTORS OPERATING IN INTRAUTERINE LIFE.

CAUSES:-

Soul-Papa:- sins of past life of individuals and of parents are responsible for

foetal abnormalities and idiopathic diseases.

Herediatary Factors:- Gross defects in sperm,ova give rise to sterility or

abortion.Defective chromosomes and genes[Beejabhagavayava]are responsible for abnormalities of blood cells.

Consanguinity:- Avoid marriage in close relatives. Chances  of inheriting

hereditary diseases are increased.

Constitude:- parents should not have same disease, constitution e.g. both have Kapha constitution, child is likely to have Kapha diseases.

PANDU ROGA

Etymology: - The word Pandu is derived from the root ‘PADI-NASANE’ with suffix ‘KU’ and elaboration through ‘NI’.

LITERARY MEANING:-

According to various disctionary the word Pandu is described as white,yellowish white etc.According to ‘Amarakosa’word Pandu means a white colour mixed with yellowish tinge.’Vachaspatyam’refers Pandu as mixture of white and yellow colour which resembles with the pollen grains of ketaki flower.’Chakrapani’described in his commentary on Charaka Samhita that there may be various modification of colour such as yellow, green,black under the category of Pandu Roga but as the disease condition it is characterized by pallor as the prominent sign.

HISTORICAL BACKGROUND:-

VAIDIKA KALA: - The disease Pandu is known to this country since ancient time right from Vedic period.In Rgveda and Atharvaveda Pandu Roga is mentioned by terms like Vilohita,Halimaka.

PAURANIKA KALA:- During Pauranika period a detail description of Pandu Roga is available in Garudapurana, Agnipurana,Mahabharat,Valmiki Ramayana,Yogavasistha etc.Garudapurana has also mentioned the treatment of disease using Loha Churna administered with Takra.

PANDU ROGA IN AYURVEDIC TEXTS: - The various authors

Charaka,Susruta,Vaghabahta,Kasyapa,Bhela,Harita,Sarangadhara,Bhavprakash and Vangasena have used the word Pandu in relation with Pandu Roga or Pandu Varna at various places in their texts.

ADHUNIKA KALA: - In the year 1554 Johan Louge for the first time described‘Chlorosis’ in western medicine. Till that period the tem Anemia was not in use in the western countries.The use of term anemia started from 17th century and was probably defined during the 19th century.

ETIOLOGY OF PANDU ROGA:- The general etiology or ‘Samanya Nidana of Pandu Roga is described in Charaka Samhita ,Susruta Samhita which all factors mainly related to Ahara,Vihara and Nidanarthakara Vyadhi.

            Nidan of Pandu can be broadly classified into following three categories.

1. Causes related to Ahara or Food
2. Causes related to Vihara or Regimen.
3. Causes related to Nidanarthakar Vyadhi or Other illness.

1. Causes related to Ahara or Food :- Food or diet plays an important role in the normal development and maintainance of the different Dhatus of body.Pandu may be caused due to indulgence of food containing more Amla,Ksara,Lavana,Kasaya Rasa,More intake of Carbohydrate, only milkand clay,produces anemia.In food derived from grains, Iron often froms a stable complex with phytates and only small amount of such iron can be converted to absorbable form.Protin in dairy products generally have little effect on iron absorption.Asatmya Bhojana,Viruddha Bhojana may inhibit normal process by producing Ama or anti substance and may lead to disturbance of the digestive and assimilative process.

2. Causes related to Vihara or Regimen:- This factor deals with both mental and physical activities of individual.In physical activities, Ratrijagarana causes Vata Prakopa ,Diwaswapa causes Kapha Prakopa.Due to Ativyayama,Ativyavaya,Adhika Srama Caloric output,out balancig of calories in the food takes place ,which is the cause of Pandu Roga. Vegas are natural regulators of body functions.Habitual suppression of optimal positive health was always taken into consideration of all factors however minor they may apper.Climatic changes or disturbance or abnormal season upset the normal function of the body.
         In the mental activities ,Chinta,Soka are main causes of Pandu Roga .As the majority of the persons fall in poor or lower middle income groups.Hence Chita can be considered one of the constant factor in all types of Pandu.If persons takes balance diet with worries even at properly digested.The result of Mandagni and deficient nutrition to Dhatus which is started to be the causes of Pandu Roga .It is said that during Krodha there are RBC destruction in more numbers than normal.

3. Causes related to Nidanarthakar Vyadhi or Other illness:- Ayurveda literature has indicated a co-relation of various diseases with Pandu Roga either as a symptom or as an Upadrava.So all these can be cause of Pandu or Nidanarthakara Roga of Pandu.
        During menstruation iron loss is more than normal,which causes Pandu.In Krimi Roga hookworms sucks blood from intestine.In Amlapitta or gastric ulcers using of antacids restricts absorption of iron,as gastric acid facilitates absorption of ferric iron and food iron.

AHARAJA HETU

VIHARAJA HETU

NIDANARTHAKARA ROGA

SAMPRAPTI OF JANMABAL PRAVRUT  PANDU ROGA:-

According to references of samhitas the samprapti of Janmabal Pravrut

Pandu Roga is given as
 
                              When the Janmabal pravrut purisha vitiated pitta located in its

normal abode of heart, becomes expelled by the vitiated vayu it gains entry into the

Dasa Dhamani and is mobilized throughout the body. It gets localized and obstructed

between the twak and mamsa and sira vitiates kapha,vayu,rakta,twak and mamsa

Subsequently it causes a variety of colours in the skin such as Pandu,Haridra and

Harita and soth on sandhi.This condition is known as Janmabal Pravrut Pandu Roga.

SAMPRAPTI GHATAKA OF PANDU ROGA

DOSA:- If we divide symptoms according to their respective dosas,than it is evident

That vitiation of Pachaka Pitta is responsible for Agnimandya,Avipaka,Aruchi and

Dhatu Shaithilya.The vitiation of Ranjaka Pitta is responsible for discolouration of

skin.The vitiation of Sadhaka Pitta denotes Anger,Lessened speech, vitiation of

Alochaka Pitta is responsible for the yellowish discolouration of eyes and yellow

tinged vision.The vitiation of Kledaka Kapha is responsible for Gaurava,Nidraluta

agnimandya etc.

      Thus it proves that each of the Dosas involved in the causation of the disease

makes its own contribution towards the diseases as a whole.

DUSYA:- Vaghabahta implicate Twak,Takta and Mamsa as the dominant Dhatus

vitiated in Pandu Roga.      

                  The symptomas such as aruchi,Jwara ,Panduta are indicateive of vitiated

Rasa Dhatu,Angamarda indicates both Rasa and Rakta Dhatu.Atisweda and

Swedabhava are suggestive of the vitiated Twak,Mamsa and Meda.Depletion of

Loma is an important indicative of vitiated Asthi Dhatu.Bhrama,Tamodarsana

indicative vitiation of Majja Dhatu.The loss of  lusture and debility are suggestive of

a depletion of Sukra as well as of Oja.It is interesting to note that this disease

manifests the depletion of Ojas in the form of depressed sense faculties as well as a

vitiated thought process.
 
     
SAMPRAPTI VIGHATANA  :- In order to control or cure the disease it is

 important that a thorough understanding of the various aspects of Samprapti .A

detailed study of JANMABAL PRAVRUT PANDU ROGA through its various stages

may be explained as under:-

SANCHAYAVASTHA:- This is the first stages or Avastha of Satkriyakala

mentioned by Susruta in which Dosas get enhanced in their own seats that in

Sthanas.During this stage the Dosas are very minutely strong to produce any disease

and so they must be treated in this stage and due to their less competence they can be

treated easily and do not get more strength for the further stage.If they are not treated

there after they do not respond easily to the treatment.

      In  this stage because of Agnivikrti first of all Jatharagnimandya takes place

which causes vitiation of Tridosa.The Pitta gets aggrevated  at its normal abode of

heart.Singh and symptoms produced in this stage are like Aruchi, Agnimandya,which

are indicative of vitiation of Pachaka Pitta.

PRAKOPAVASTHA:- This is the second stage of Satkriyakala followed by the

Dosas because of no treatment during the Sanchayavastha .In this stage Dosas get

more and more accumulated in their own seats and become prone to spread all over

the body but they don't spread.

       In the case of Janmabal Pravrut Pandu ,it is well explained that excessively

vitaited pitta Dosas become prone to move out of the Hrdaya,which is supported by

vitiated Vyana Vayu.Following this movement Dosas produce the symptoms like

Gaurava,Tandra, Angasada .

PRASARAVASTHA:-This is the third stage of Satkriyakala.The Dosas in

Prakopavastha start to migrate all over tthe body throughout the Rasavaha,Raktavaha

and Mamsavaha Srotasa.The symptoms manifested in both the prevous stages

become more and more progressive in this stage due to migration of Dosas in the

body.In this stage it is rather easy to treat the disease.

STHANA SANSRAYAVASTHA:- The migrating Dosas in this stage take their seat

at a particular preplanned place that is Kha-Vagunya, which is also created by the

Nidana Sevana as per the references.This is the stage of Dosa DUsya Samurchhana in

which Dosas meet with Dusyas and manifest the sigh and symptoms which are

consider as Purvarupas.

      The progress of this stage can be defined into two phases.In these phases the

Dosas combine with the Dusyas and Mainfest the certain characteristics which are

indicative of the future illness and are known as Samanya Purvarupa. But there is the

specification of Dosas and Dsyas to create future ill ness,at that time ,which

symptoms are manifested  are the indicative ofm Visista Purvarupa.

      The list of Purvarupa of Janmabal Pravrut Pandu  according to references shown

in the table of Purvarupa.

VYAKTAVASTHA:-In this stage all the symptoms are clearly manifested due to

Dosa Dusya Samurcchana.Acharyas have described the rupa or Samanya Laksana of

disease which are manifested in this stage.

      In Janmabal Pravrut Pandu samanya laksanas are Jwara,Bhrama ,Gaurava,Santhi

Shool ,Soth etc.

BHEDAVASTHA:-There are two definitions being considered about

Bhedavastha.Some Acharyas including Susruta have defined it as the chronicity that

is Jirnavastha of the disease and others define as the disease entity,that is Roga

Prakara.

      Roga Prakara are considering the Dosa dominancy in Vyadhi and according to

that of Vattaj,Pittaj,Kaphaj and Sannipataja.Theses four entities of Janmabal Pravrut

Pandu are included in this stage.

PURVARUPA OF PANDU ROGA :- Various predisposing symptoms are

described in classics which persists even after the manifestation of the disease

Janmabal Pravrut Pandu.

      Classical texts mentioned the following symptoms under the heading of

Purvarupa of Janmabal Pravrut Pandu

SAMANYA RUPA OF PANDU ROGA:- The signs and symptoma indicate the
complete manifestation of disease.The general symptoms of Janmabal Pravrut Pandu are shown in table as given below.

Paandu -Treatment

• Abhraka bhasma, 125 to 375 mg with honey / ghee / triphalaa kvaatha / gudoochee svarasa / aardraka svarasa. (RT)
• Asoka ghruta, 12 g., with warm water / warm milk. (BR)
• Ayaskruti, 12 to 24 ml. (AH)
• Chandana balaa laakshaadi taila, 6 g., with milk / warm water. Also used externally for abhyanga. (YR)
• Chandra prabhaa vatee, 250 to 500 mg wrih water / milk / ginger powder. (SS)
• Chaturmukha rasa, 125 mg with triphalaa kvaatha / honey. (BR)
• Daadimaadi ghruta, 48 g., with warm water. (AH)
• Dantee hareetakee, half to one hareetakee and 6 to 12 g. of leha, with water. (AH)
• Dasa moola shatpalaka ghruta, 12 g., with warm milk / warm water. (CD)
• Dhaanvantara ghruta, 48 g., with warm water. (AH)
• Dhaatree lauha, 0.5 to 1 g., with ghee / honey. (BR)
• Draakshaava leha, 6 to 12 g with water / milk. (AH)
• Dugdha vatee (Sotha), 60 mg with milk. (BR)
• Elaadi ghruta, 12 g., with milk / warm water. (AH)
• Harataala bhasma, 31.25 to 125 mg with honey / butter. (RRS)
• Hingu vachaadi choorna, 2 to 4 g., with.buttermilk / warm water. (AH)
• Huta bhugaadi choorna, 3 to 6 g.with thin buttermilk. (SY)
• Kaanta vallabha rasa, 125 mg with honey. (VY)
• Kaaseesa bhasma, 250 mg with baakuchee choorna /triphalaa kvaatha / madhu. (RM)
• Kalyaanaka ghruta, 12 g., with warm milk /warm water. (AH)
• Khadiraarishta, 12 to 24 ml. (S3)
• Laghu chinchaadika lehya, 6 g., with buttermilk. (SY)
• Laghvaananda rasa, 250 mg,, with betel leaf and honey. (RSS)
• Lauha parpatee, 250 mg with milk / buttermilk / bhrushta jeeraka choorna /daadima svarasa. (SY)
• Loha bhasma, 125 to 250 mg with honey / ghee /trikatu choorna / triphalaa choorna / haridraa rasa. (RT)
• Lohaasava, 12 to 24 ml. (SS)
• Mahaa kalyaanaka ghruta, 12 g., with warm milk / warm water. (AH)
• Mahaa tiktaka ghruta, 6 g., with milk / warm water. (BR)
• Mandoora bhasma, 250 to 500 mg with honey / triphalaa kvaatha / punarnavaashtaka kvaatha / punarvava rasa. (RT)
• Mandoora vataka, 1 g., with buttermilk / honey. (AH)
• Nava ratna raaja mrugaanka rasa, 125 mg with pippalee choorna / honey / gudoochee saliva / butter. (YR)
• Navaayasa choorna, 1 g with honey / water. (BR)
• Praanadaa gutikaa, 2 to 4 mg with honey / water. (BR)
• Pradaraantaka lauha, 500 mg with honey / sugar / ghee. (BR)
• Punarnavaadi mandoora, 1 g., with water / buttermilk. (CS)
• Puta pakva visharna jvaraantaka lauha, 250 mg with pippalee / hingu / saindhava / honey / gudoochee svarasa / sephaaiee svarasa. (RSS)
• Rajanyaadi choorna, 0.5 to 2 g., with ghee / honey. (AH)
• Rasa parpatee. 250 mg. to 1000 mg (to be increased gradually), with milk / buttermilk / jeeraka kvaatha (BR)
• Rodhraasava (Lodhraasava), 12 to 24 ml. (AH)
• Sivaa gutikaa (laghu), 6 g., with water on empty stomach. (YR)
• Sivaa gutikaa, 12 g., with milk / maamsa rasa / daadima rasa / mrudveekaa rasa / aasavaarishtaa. (AS)
• Soola vajrinee vatikaa, 25 mg with warm water. (RSS)
• Sree nrupati vallabha rasa, 250 mg.with aardraka svarasa / honey / dhaatree svarasa. (BR)
• Svarna bhasma, 15.5 to 62.5 mg with honey / butter. (RT)
• Svarna maakshika bhasma, 125 to 250 mg , with aardraka svarasa / pippalee choorna (YR)
• Taamra bhasma, 31.25 to 62.5 mg with trikatu kashaaya /ghee / honey / duraalabhaa kvaatha / aardraka rasa / gudoochee rasa (Ay.P)
• Vaari soshana rasa, 62.5 to 125 mg with trikatu kvaatha / triphalaa kvaatha / kaakodumbarikaa rasa. (BR)
• Vaasaa chandanaadi taila, to be used externally for abhyanga. (BR)
• Vaasaa gudoochyaadi kvaatha choorna, 48 g., with honey. (AH)
• Vaikraanta bhasma, 62.5 mg with honey / ghee. (RT)
• Vajra bhasma, 8 mg with honey / santaanikaa. (RT)
• Vanga bhasma, 125 to 250 mg with gudoochee svarasa / gudoochee sattva / honey / ghee / haridraa rasa. (RT)
• Vidangaadi lauha, 250 mg. with honey / buttermilk. (BR)

Abbreviations

RASAVAHA SROTAS
                        = Channels carrying body fluid
                       
                        Constituted of
                                                Blood vessels
                                                Lymphatic
                         Vitiated if
                                                Worrying excess
                                                Excessive eating heavy substances
                                                Excessive eating cold substances
                                                Excessive eating oily substances
                        Symptoms of vitiation
                                                Disinclination for food
                                                Anorexia
                                                Nausea
                                                Impaired sensation of taste
                                                Heaviness
                                                Fever with body ache
                                                Loss of digestive power
                                                Premature wrinkling of skin
                                                Premature graying of hair
                        If injured
                                                Wasting
                                                Fainting
                                                Unconsciousness
                                                Death
                        Treatment
                                                Fasting

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RAKTAVAHA SROTAS
                                    = Consists of liver, store blood, SPLEEN (MOOLA) are site
                                    of origin.
                       
                        Factors for vitiation
                                                1.   Use of concentrated / hot wines or similar
                                                2.   Excessive use of salt, alkalis, acids, pungent articles
                                                3    Use of horse gram, black gram, seasame oil
                                                4.   Use leafy vegetables
                                                5.   Use flesh of aquatic animals
                                                6.   Use curds, sour kanjee, whey, vinegar, souveeraka
                                                      wines (acidic fermentations)           
                                                7.   Incompatible articles
                                                8.   Left food or having bad smell
                                                9.   Sleeping during day time after eating, liquid,
                                                      unctuous, heavy food
                                                10. Indulgence in over eating
                                                11. Anger, grief
                                                12. Exposure to sun, fire
                                                13. Suppression of urge of vomiting
                                                14. Blood letting at improper season
                                                15. Fatigue, injury
                                                16. Indigestion, eating on loaded stomach
                                                      eating food before previous meal is digested
                                                17. Natural tendency of autumn season (Sharad rutu)
                        If vitiated
                                                1.   Skin disease
                                                2.   Acutely spreading disease
                                                3.   Menorrhagia                                  
                                                4.   Inflammation of rectum
                                                5.   Inflammation of penis
                                                6.   Inflammation of  mouth
                                                7.   Splenomegaly
                                                8.   Gulma
                                                9.   Abcesses
                                                10. Bluish black mole
                                                11. Jaundice
                                                12. Ring worm
                                                13. Leukoderma
                                                14. Papules
                                                15. Redish / Wheels
                                                16. Circular patches

                        If injured
                                                1.  Pallor         
                                                2.  Cynosis
                                                3.  Fever
                                                4.  Burning sensation
                                                5.  Haemorrhage
                                                6.  Redness of eyes
                        Treatment
                                                Raktapitta Chikitsa

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MAMSAVAHA SROTAS
                        = Channels carrying nutrients to muscular tissue
                       
                        Consists of                              
                                                Blood vessels, Lymphatic, Nerves – Supplying muscles
                        Vitiated if
                                                Sleeping during day after meal
                                                Consuming large quantity of heavy food for long time
                        Symptoms
                                                Granuloma
                                                Malignant tumors         
                                                Piles
                                                Warts
                                                Sloughing of muscles
                                                Dry gangrene
                        If injured
                                                Swelling
                                                Atrophy of muscles
                                                Appearance of varicose venis
                                                Death
                        Treatment
                                                Body purification – Panchakarma
                                                Operative measures
                                                Cuterisation (Ksharkarma)
                                               

            MAJJAVAHA SROTAS
                        Nutrients to nervous tissue bone marrow and nerves.
           
                        Vitiated if
                                                Crush injuries
                                                Compression of bones
                                                Indulgence in incompatible food items
                        Disease
                                                Pain in joints
                                                Giddiness
                                                Fainting
                                                Deep seated wounds in joints
                        Treatment
                                                Dist : sweet, bitter
                                                Medicine : sweet, bitter
                                                Exercise
                                                Emetics in spring season           
                                                Purgatives – in autumn season

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