AIAPGET Points
– Twak Sphotana & Prekshanakuta Shotha are specific Purvarupas of Pandu Roga (Su.Ut.44/5).
– Excessive consumption of Apathya Ahara, Madhya and Amla Anna by Pandu Rogi leads to manifestation of Kamala Roga.
– MAHAN SHOPHA and PARVABHEDA are symptoms of KUMBHASAHVA (Kumbha Kamala), a variety of Kamala.
– LAGHARAKA & ALASA are conditions / variants of Kamala wherein Kamala is associated with Jwara, Angamarda, Brahma, Sada, Tandra & Kshaya.
– HALIMAKA is a variant of Kamala caused by Vata and Pitta. It is marked by the appearance of HARITA, PITA & NILA Varna.
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The 44th chapter of Uttaratantra of Sushruta Samhita is named as Panduroga Pratiṣedha Adhyaya. This chapter deals with the Treatment of Anaemia.
अथातः पाण्डुरोगप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Panduroga pratiṣedha – treatment of Anaemia; as
revealed by the venerable Dhañvañtari.
Nidāna- causes
व्यवायमम्लं लवणानि मद्यं मृदं दिवास्वप्नमतीव तीक्ष्णम् |
निषेवमाणस्य विदूष्य रक्तं कुर्वन्ति दोषास्त्वचि पाण्डुभावम् ||३||
Below mentioned are the causes of Pandu Roga –
Indulgence in –
– too much copulation,
– sours and salts,
– wine,
– habit of eating mud,
– day sleep and
– penetrating foods
Due to the above mentioned causes, the doshas would get aggravated. These aggravated doshas vitiate the blood and bring about pandu bhava (change of normal body colour to pale or yellowish white colour) of the skin.
पाण्ड्वामयोऽष्टार्धविधः प्रदिष्टः पृथक्समस्तैर्युगपच्च दोषैः |
सर्वेषु चैतेष्विह पाण्डुभावो यतोऽधिकोऽतः खलु पाण्डुरोगः ||४||
Panduroga is said to be of four kinds –
– one from each dosha separately – vataja, pittaja and kaphaja,
– one from the combination of all three doshas – sannipataja, tridoshaja
It is called pandu roga because of the predominance of pallor / yellowish white colour in all these kinds.
Pūrvarūpa – premonitory symptoms
त्वक्स्फोटनं ष्ठीवनगात्रसादौ मृद्भक्षणं प्रेक्षणकूटशोथः |
विण्मूत्रपीतत्वमथाविपाको भविष्यतस्तस्य पुरःसराणि ||५||
Below mentioned are the premonitory symptoms of the disease (pandu roga) –
– cracking of the skin,
– excessive spitting,
– general debility,
– desire to eat mud,
– swelling of eye socket,
– yellowish white colour of the faeces and urine and
– improper digestion of the food
Paryāyanāma – synonyms
स कामलापानकिपाण्डुरोगः कुम्भाह्वयो लाघर(व)कोऽलसाख्यः |
विभाष्यते लक्षणमस्य कृत्स्नं निबोध वक्ष्याम्यनुपूर्वशस्तत् ||६||
Below mentioned are the synonyms of Panduroga –
– Kamala,
– Apanaki,
– Panduroga,
– Kumbhakamala,
– Lagharaka and
– Alasa
Now, the features of these types will be described by me in succeeding order.
Vataja panduroga
कृष्णेक्षणं कृष्णसिरावनद्धं तद्वर्णविण्मूत्रनखाननं च |
वातेन पाण्डुं मनुजं व्यवस्येद्युक्तं तथाऽन्यैस्तदुपद्रवैश्च ||७||
Symptoms of Panduroga produced by Vata –
– eyes become black,
– prominent network of black veins appear on the body,
– black colour of skin, faeces, urine, nails and face and
– other symptoms of vata aggravation
Pittaja Panduroga
पीतेक्षणं पीतसिरावनद्धं तद्वर्णविण्मूत्रनखाननं च |
पित्तेन पाण्डुं मनुजं व्यवस्येद्युक्तं तथाऽन्यैस्तदुपद्रवैश्च ||८||
Symptoms of Panduroga caused by Pitta –
– eyes become yellow in colour,
– appearance of yellow network of veins on the body,
– yellow colour of the skin, faeces, urine, nails and face and
– manifestation of other symptoms of pitta aggravation
Kaphaja panduroga
शुक्लेक्षणं शुक्लसिरावनद्धं तद्वर्णविण्मूत्रनखाननं च |
कफेन पाण्डुं मनुजं व्यवस्येद्युक्तं तथाऽन्यैस्तदुपद्रवैश्च ||९||
Symptoms of Panduroga caused by Kapha –
– eyes become white in colour,
– appearance of whitish network of veins on the body,
– white colour of the skin, faeces, urine, nails and face and
– manifestation of other symptoms of kapha aggravation
Tridoşaja panduroga
सर्वात्मके सर्वमिदं व्यवस्येद् वक्ष्यामि लिङ्गान्यथ कामलायाः |
Symptoms of all the doshas will be present together in Panduroga produced by all the doshas together.
Kāmalāroga – Jaundice
यो ह्यामयान्ते सहसाऽन्नमम्लमद्यादपथ्यानि च तस्य पित्तम् ||१०||
करोति पाण्डुं वदनं विशेषात् पूर्वेरितौ [१] तन्द्रिबलक्षयौ च |११|
Now, the causes, pathogenesis and symptoms of Kamala will be described by me.
At the end of Pandu Roga i.e. soon after panduroga gets cured, if the person indulges in foods which are sour, consumes wine and indulges in unhealthy foods and activities, the pitta would get greatly aggravated. This aggravated pitta produces yellowish-white colour, especially in the face. Associated with this, is stupor and loss of strength.
भेदस्तु तस्याः खलु कुम्भसाह्वः शोफो महांस्तत्र च पर्वभेदः ||११||
Kumbhasahva or Kumbha Kamala is a variety of Kamala. This disease is marked by profound swelling (oedema) of the body and pain in the joints.
ज्वराङ्गमर्दभ्रमसादतन्द्राक्षयान्वितो लाघर(व)कोऽलसाख्यः |१२|
The same Kamala is known as Lagharaka and Alasa when it is associated with the below mentioned symptoms –
– fever,
– aches in the body parts,
– giddiness,
– debility,
– stupor,
– depletion of tissues
तं वातपित्ताद्धरिपीतनीलं हलीमकं नाम वदन्ति तज्ज्ञाः ||१२||
The same Kamala is called as Halimaka when green, yellow or blue colour appears due to aggravation of vata and pitta.
उपद्रवास्तेष्वरुचिः पिपासा छर्दिर्ज्वरो मूर्धरुजाऽग्निसादः |
शोफस्तथा कण्ठगतोऽबलत्वं मूर्च्छा क्लमो हृद्यवपीडनं च ||१३||
Below mentioned are the complications of these diseases –
– loss of taste or appetite,
– thirst,
– vomiting,
– fever,
– headache,
– weakness of digestive fire,
– swelling of the throat,
– debility,
– fainting,
– exhaustion,
– discomfort in the region of the heart
Panduroga cikitsā – treatment of anaemia
साध्यं तु पाण्ड्वामयिनं समीक्ष्य स्निग्धं घृतेनोर्ध्वमधश्च शुद्धम् |
सम्पादयेत् क्षौद्रघृतप्रगाढैर्हरीतकीचूर्णयुतैः प्रयोगैः ||१४||
पिबेद्घृतं वा रजनीविपक्वं यत्त्रैफलं तैल्वकमेव वाऽपि |
विरेचनद्रव्यकृतं पिबेद्वा योगांश्च वैरेचनिकान् घृतेन ||१५||
If the Pandu Roga is curable, it should be treated. In these curable conditions, below mentioned treatments should be given –
– oleation therapy should be given using ghee, following which,
– purification in both upward and downward directions should be administered i.e. both vamana – emesis and virechana – purgation should be given, and then,
– powder of Haritaki added with more quantity of honey and ghee should be given or
– ghee boiled with Rajani or
– Triphala Ghrta should be given,
– Tilvaka Ghrta or ghee boiled and prepared with purgative herbs shall be administered
मूत्रे निकुम्भार्धपलं विपाच्य पिबेदभीक्ष्णं कुडवार्धमात्रम् |
खादेद्गुडं वाऽप्यभयाविपक्वमारग्वधादिक्वथितं पिबेद्वा ||१६||
Half pala (20 gm) of Nikumbha (Danti) should be boiled in cow’s urine. Half Kudava (80ml) of this preparation should be consumed.
Alternatively, guda – jaggery cooked with Abhaya should be given.
Or, Decoction of herbs belonging to Aragvadhadi Gana should be given for drinking.
All these recipes are meant to produce purgation.
अयोरजोव्योषविडङ्गचूर्णं लिह्याद्धरिद्रां त्रिफलान्वितां वा |
सर्पिर्मधुभ्यां विदधीत वाऽपि शास्त्रप्रदेशाभिहितांश्च योगान् ||१७||
Below mentioned formulations may be administered to the patient –
– ayoraja i.e. iron fillings or ash of iron mixed with powder of vyosa – trikatu and vidanga, or
– powder of haridra and triphala – added with ghee and honey or
– any other formulae of iron mentioned elsewhere in the text
हरेच्च दोषान् बहुशोऽल्पमात्रान् श्वयेद्धि दोषेष्वतिनिर्हृतेषु |
धात्रीफलानां रसमिक्षुजं च मन्थं पिबेत् क्षौद्रयुतं हिताशी ||१८||
Many times, the doshas should be expelled in small quantities.
If the doshas are expelled in large quantities, they would produce swelling.
In these cases, mantha should be prepared by churning well the juice of Dhatri Phala – gooseberry fruits and Iksu – sugarcane. It should be consumed mixed with honey.
उमे बृहत्यौ रजनीं शुकाख्यां काकादनीं चापि सकाकमाचीम् |
आदारिबिम्बीं सकदम्बपुष्पीं विपाच्य सर्पिर्विपचेत् कषाये ||१९||
तत् पाण्डुतां हन्त्युपयुज्यमानं क्षीरेण वा मागधिका यथाग्नि |२०|
Decoction of the below mentioned ingredients should be prepared –
– two kinds of brhati,
– rajani,
– sukakhya,
– kakadani,
– kakamaci,
– adari,
– bimbi,
– kadamba puspi
This decoction is added with ghee, processed and medicated ghee is prepared. When this ghee is consumed along with milk or Magadhika – Pippali, it cures Panduroga – anaemia.
हितं च यष्टीमधुजं कषायं चूर्णं समं वा मधुनाऽवलिह्यात् ||२०||
Decoction of Yastimadhu – licorice should be taken with equal quantity of honey. Alternatively, the powder of Yasthimadhu can also be administered mixed with honey.
गोमूत्रयुक्तं त्रिफलादलानां दत्त्वाऽऽयसं चूर्णमनल्पकालम् |
प्रवालमुक्ताञ्जनशङ्खचूर्णं लिह्यात्तथा काञ्चनगैरिकोत्थम् ||२१||
Below mentioned formulations taken for long periods of time cures Pandu Roga –
– Triphala and Ayas (iron) with cow’s urine or
– Powder of Pravala, Mukta, Anjana, Sankha and Kancana Gairika (Suvarna Gairika)
आजं शकृत्स्यात् कुडवप्रमाणं विडं हरिद्रा लवणोत्तमं च |
पृथक् पलांशानि समग्रमेतच्चूर्णं हिताशी मधुनाऽवलिह्यात् ||२२||
1 kudava (160 gm) of the powder of excreta of goat should be consumed (lick) along with 1 pala each (40 gm) of Bida Lavana, Haridra and Saindhava Lavana mixed with honey by the patient who desires good health.
मण्डूरलोहाग्निविडङ्गपथ्याव्योषांशकः सर्वसमानताप्यः |
मूत्रासुतोऽयं मधुनाऽवलेहः पाण्ड्वामयं हन्त्यचिरेण घोरम् ||२३||
Equal parts of the below mentioned ingredients should be taken –
– Mandura Loha – iron slag,
– Agni – Citraka,
– Vidanga,
– Pathya and
– Vyosa
This should be added with equal parts of (of all the above ingredients) tapya (iron pyrites) and soaked in cow’s urine for some days. Later this should be consumed. This recipe would cure even dreadful (severe) conditions of Pandu Roga quickly.
बिभीतकायोमलनागराणां चूर्णं तिलानां च गुडश्च मुख्यः |
तक्रानुपानो वटकः प्रयुक्तः क्षिणोति घोरानपि पाण्डुरोगान् ||२४||
The nice powder of equal quantities of Vibhitaki, Ayomala (iron slag), Nagara and Tila is added with equal quantities of jaggery and made into pills. When these pills are consumed followed by drinking buttermilk, they cure Pandu Roga, even when it is of severe nature.
सौवर्चलं हिङ्गु किराततिक्तं कलायमात्राणि सुखाम्बुना वा |
मूर्वाहरिद्रामलकं च लिह्यात् स्थितं गवां सप्तदिनानि मूत्रे ||२५||
Equal quantities of powder of Sauvarcala, Hingu and Kiratatikta are taken. They are made into pills the size of pea. These pills may be consumed along with warm water.
Alternatively, powder of Murva, Haridra and Amalaka are kept soaked in cow’s urine for seven days and is later consumed.
मूलं बलाचित्रकयोः पिबेद्वा पाण्ड्वामयार्तोऽक्षसमं हिताशी |
सुखाम्बुना वा लवणेन तुल्यं शिग्रोः फलं क्षीरभुजोपयोज्यम् ||२६||
Powder of root of Bala and Citraka, one aksa (10 gm) in quantity should be consumed by patients of Pandu Roga along with comfortable warm water.
Alternatively, fruit of Sigru may be consumed with equal quantities of Saindhava Lavana, with food, along with milk.
न्यग्रोधवर्गस्य पिबेत् कषायं शीतं सिताक्षौद्रयुतं हिताशी |
शालादिकं चाप्यथ सारचूर्णं धात्रीफलं वा मधुनाऽवलिह्यात् ||२७||
Decoction of herbs belonging to Nyagrodadi Gana group should be consumed by patients desirous of cure from Pandu Roga. This decoction should be consumed with sugar and honey in a cold state.
Alternatively, the patient should consume powder of herbs belonging to the Saladi Gana group or powder of Amalaka mixed with honey.
विडङ्गमुस्तत्रिफलाजमोदपरूषकव्योषविनिर्दहन्यः |
चूर्णानि कृत्वा गुडशर्करे च तथैव सर्पिर्मधुनी शुभे च ||२८||
सम्भारमेतद्विपचेन्निधाय सारोदके सारवतो गणस्य |
जातं च लेह्यं मतिमान् विदित्वा निधापयेन्मोक्षकजे समुद्गे ||२९||
हन्त्येष लेहः खलु पाण्डुरोगं सशोथमुग्रामपि कामलां च |३०|
Powder of below mentioned ingredients should be prepared –
– Vidanga,
– Musta,
– Triphala,
– Ajamoda,
– Parusaka,
– Vyosa,
– Vinirdahani (Citraka),
– Guda – jaggery and
– Sarkara – sugar
This powder is cooked in the decoction of herbs belonging to Salasaradi Gana group and confection is prepared.
Honey and ghee is added to this confection and it is preserved in a box prepared from Muskaka tree wood.
When consumed, this confection cures Pandu Roga associated with oedema. It also cures severe conditions of Kamala – jaundice.
Kāmalā cikitsā – treatment of jaundice
सशर्करा कामलिनां त्रिभण्डी हिता गवाक्षी सगुडा च शुण्ठी ||३०||
Powder of Tribhandi (Trivrt) or Gavaksi should be added with jaggery and ginger and administered to the patients of Kamala.
कालेयके चापि घृतं विपक्वं हितं च तत् स्याद्रजनीविमिश्रम् |३१|
Medicated ghee prepared with Kaliyaka is also beneficial when consumed, mixed with powder of Rajani.
धातुं नदीजं जतु शैलजं वा कुम्भाह्वये मूत्रयुतं [१] पिबेद्वा ||३१||
मूत्रे स्थितं सैन्धवसम्प्रयुक्तं मासं पिबेद्वाऽपि हि लोहकिट्टम् |३२|
The patient suffering from Kumbha Kamala should consume the below mentioned formulations –
– powder of Nadija Dhatu (Maksika) or Silajatu with cow’s urine or
– Loha Kitta or Mandura (iron slag) along with Saindhava Lavana
These formulas should be kept soaked in cow’s urine for one month and then consumed.
दग्ध्वाऽक्षकाष्ठैर्मलमायसं वा गोमूत्रनिर्वापितमष्टवारान् ||३२||
विचूर्ण्य लीढं मधुनाऽचिरेण कुम्भाह्वयं पाण्डुगदं निहन्यात् |
Ayomala (iron slag) is burnt in the fire of wood of aksa / bibhitaki (fire obtained by burning wood of aksa) to form ash.
This ash should be soaked in cow’s urine for seven times. Then this is powdered and licked with honey. This quickly cures pānduroga named kumbahvaya or kumbhakamala.
सिन्धूद्भवं वाऽग्निसमं च कृत्वा क्षिप्त्वा च मूत्रे सकृदेव तप्तम् ||३३||
लौहं च किट्टं बहुशश्च तप्त्वा निर्वाप्य मूत्रे बहुशस्तथैव |
एकीकृतं गोजलपिष्टमेतदैकध्यमावाप्य पचेदुखायाम् ||३४||
यथा न दह्येत तथा विशुष्कं चूर्णीकृतं पेयमुदश्विता तत् |
तक्रौदनाशी विजयेत रोगं पाण्डुं तथा दीपयतेऽनलं च ||३५||
Saindhava lavana should be burnt hot (on the fire of bibhitaki wood) and dipped in cow’s urine. Later lohakitta should be burnt hot (on the fire of bibhitaki wood) and dipped in cow’s urine. This lohakitta is burnt many times and dipped in cow’s urine many times. This should be done for a minimum of seven times. Equal quantities of saindhava lavana and lohakitta are ground in mortar with cow’s urine. The mixture is put in a big pan having cow’s urine and is boiled. While the contents are being boiled they are constantly stirred so that the contents don’t get burnt / charred. When the contents get dried (devoid of wetness), the pan is removed from the fire. The contents are further dried, ground, made into powder and stored in an airtight container. This should be consumed along with dilute buttermilk. After the digestion of medicine one should partake food along with buttermilk. This recipe cures anaemia (kumbhakamala) and also kindles digestion.
द्राक्षागुडूच्यामलकीरसैश्च सिद्धं घृतं लाघर(व)के हितं च |
गौडानरिष्टान् मधुशर्कराश्च मूत्रासवान् क्षारकृतांस्तथैव ||३६||
स्निग्धान् रसानामलकैरुपेतान् कोलान्वितान् वाऽपि हि जाङ्गलानाम् |
सेवेत शोफाभिहितांश्च योगान् पाण्ड्वामयी शालियवांश्च नित्यम् ||३७||
To cure Lagharaka, medicated ghee prepared with Draksa, Guduci and juice of Amalaki should be administered.
Patients of Pandu Roga should use the below mentioned –
– arista prepared with jaggery, honey and sugar,
– asava prepared with urines and ksaras,
– soup of meat added with fats and juice of Amalaka,
– soup of meat of animals living in arid lands processed (added) with Kola
One should also consume the formulations explained in the context of sopha (treatment of swellings / oedema). He should also eat foods prepared from Sali (rice) and Yava (barley) everyday.
श्वासातिसारारुचिकासमूर्च्छातृट्छर्दि शूलज्वरशोफदाहान् |
तथाऽविपाकस्वरभेदसादान् जयेद्यथास्वं प्रसामीक्ष्य शास्त्रम् ||३८||
Complications of the disease mentioned below should be cured following the advice of the science –
– dyspnoea,
– diarrhoea,
– loss of taste,
– cough,
– fainting,
– thirst,
– vomiting,
– abdominal pain,
– fever,
– oedema,
– burning sensation,
– improper digestion,
– hoarseness and
– weakness of the body
अन्तेषु शूनं परिहीनमध्यं म्लानं तथाऽन्तेषु च मध्यशूनम् |
गुदे च शेफस्यथ मुष्कशूनं प्रताम्यमानं च विसञ्ज्ञकल्पम् ||३९||
विवर्जयेत् पाण्डुकिनं यशोऽर्थी तथाऽतिसारज्वरपीडितं च ||४०||
The patients having below mentioned symptoms of Pandu Roga should be rejected by a physician desirous of reputation –
– swelling in extremities,
– emaciation in the middle portion of the body (trunk), or
– swelling in extremities and trunk and also in anus, penis and scrotum,
– fainting often,
– loss of consciousness and
– diarrhoea and
– fever
इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे पाण्डुरोग प्रतिषेधो नाम (षष्ठोऽध्यायः, आदितः) चतुश्चत्वारिंशत्तमोऽध्यायः।।४४।।
Thus ends the forty fourth chapter by name Panduroga Pratiședha in Uttara Sthana of Suśruta Samhita.
