A Clinical Management of Pandu with Yashtimadhu Shamananga Snehapaana: A Case Study

1. INTRODUCTION

In Panduroga, Pitta being forcefully propelled by Vayu enters into the 10 vessels attached to Hridaya and circulates in the entire body. Being located between the skin and the muscle tissue, this aggravated Pitta vitiates Kapha, Vayu, Raktha, Twak and Mamsa as a result of which different types of discolouration like Pandu, Haritha, Haridra are appeared on skin. Pandu is a disease mentioned in Ayurveda classics characterized by pallor of the body with other Lakshanas like Dourbalya, Hridaya Spandana, Swaasa, and Gaatrashoola [1] Classical sign of this disease is similar with features of Iron deficiency Anaemia, which is the most prevalent nutritional deficiency disorder in the world. [2] In this disease there will be reduction in haemoglobin, number of RBCs per mm3 of blood and quantity of Hb% resulting in pallor of the skin.[3] Globally, anaemia affects 1.62 billion people, which corresponds to 24.8% of the population.[4] Pandu Roga Chikitsa includes both Shamana and Shodhana Chikitsa. In Bahudoshavastha Theekshna Shodhana is indicated. In Alpa and Madhyama Doshaavastha Shamana is ideal. According to Charaka, Ghritha possess the actions of Pitta-Anilahara, conducive to Rasadhathu, Shukradhathu and Ojas. It is Nirvapanam (cooling), Mrdukaram (softening) and Swaravarnaprasaadanam (clarity of voice and complexion). Ghritha is indicated for people who are Ksheena and Abala. Moreover Charaka considers Ghritha as Uttamasneha due to its power of effective assimilation with the properties of other drugs with which it is processed with (Samskaarasya Anuvarthanaath) .On observing the Yogas suggested by Acharyas for Pandu Roga Chikitsa, a large number of them were Ghritha Yogas suggesting the ability of Ghrithas to deal with Panduroga. [5-6] Yashtimadhu [7](Glycyrrhiza glabra) being Madhura(dominantly) Thiktha Rasa, Snigdha Guna, Sheetha Veerya, Madhura Vipaka possess Karmas Rasayana Dravya.

To understand the efficiency of Yashtimadhu Ghritha as Shamananga Snehapaana in the management of Pandu Roga (w.s.r to Iron deficiency anaemia) through clinical study.

3.1) Personal Information: A 38 years old female patient, daily wage worker by occupation with a height of 150 cm and weight of 40kg 3.2) Presenting complaints: The patient complaints of excessive tiredness, muscle cramps, difficulty in doing daily activities, breathlessness, loss of appetite and palpitation since around 5 months. 3.3) History of present illness: The patient was apparently well before 5 months. Since then, she started getting excessively tired after returning from work. She started suffering from muscle cramps and shortness of breath on doing strenuous work which worsened day by day. Loss of appetite and palpitation are associated complaints. 3.4) History of past illness – H/O Hysterectomy 1 year ago 3.5) Family History – No members in family have similar complaint. 3.6) Personal History: Bowel- Normal Appetite- Less Micturition-Normal Sleep- Normal Diet – Mixed Addictions- Nil

a) General Examination: Temperature – 37.2°C Pulse- 68/min BP-100/70mmHg Lymphadenopathy- Absent Oedema- Absent Icterus- Absent Cyanosis- Absent Pallor- Present b) Systemic Examination – No abnormalities detected in any system 3.9) Laboratory Investigation Suggested – Hb, Complete Blood Count

5. TREATMENT PLAN:

Intake of Shamanaanga Snehapaana of Yashtimadhu Ghritha (approximately 15 ml) at empty stomach in early morning for 21 days.

For the purpose of statistical assessment of results some grades and grade points considering the severity of different clinical features, and laboratory findings have been used as follows:

• Pandutha present in Nayana, Twak, Sira, Mootra & Pureesha (4to6 sites)-3 • Present in 2 or 3 sites-2 • Present in any one site-1 • Not present-0

• Not present-0 • Mild leg cramps only at night-1 • Leg cramps present in night or on exertion, needs medication-2 • Leg cramps present throughout the day-3

• Not present-0 • Shwasa on heavy work or play unaccustomed-1 • Shwasa on moderate work or play accustomed-2 • Shwasa on light work or play-3

• Not present-0 • Present, hungry dislike food-1 • Present, hamper daily activity-2

• Not present-0 • Daurbalya present, routines not hampered.-1 • Daurbalya present, routines hampered-2 • Daurbalya always present, routines hampered -3

• Absent-0 • Occassional-1 • Intermittent-2 • Present always-3

• Absent, routine not hampered-0 • Occasional, routine not hampered-1 • Intermittent, routine hampered-2 • Present always, routine hampered-3

• No Palpitation-0 • Palpitation on Unaccustomed activity-1 • Palpitation on accustomed activity-2 • Palpitation at rest-3

• No pain-0 • Bearable, doesn‘t affect routine-1 • Appears frequently and affects routine-2 • Severe pain-even Disturbs sleep-3

• Absent • Present can perform daily activity (accustomed) • Appears frequent, difficulty in performing daily activity (unaccustomed) • Absent-0 • Present, perform daily activity (accustomed)-1 • Appears frequently, perform daily activity-2 • Severe, daily activity reduced-3

• Absent-0 • Stepping up to>20 steps--1 • Between 10-20 steps-2 • Less than 10 steps-3

• The patient had Praayika Shaman of Lakshanas (75%). can be concluded that treatment modality is safe and is of therapeutic value. • The therapeutic effects like normalcy of Agni and gain of strength are due to decrease of Pandu symptoms. The ultimate effect will be correction of correction of Agnimandya and correction of physiology of Dhathus.

Probable mode of action: Yashtimadhu Ghritha consists of Yashtimadhu and Ghritha, which are mainly Vata-Pittahara in nature. Yashtimadhu possess Madhura Tiktha Rasa which pacifies Pitta .Its Gunas are Guru, Snigdha which contradicts Laghu, Tikshna Guna of Pitta. Its Sheetha Veerya aids in Shamana of the Ushna Veerya of Pitta. Vipaka being Madhura also contributes to Shamana of Pitta. The Guru Snigdha Guna also pacifies the vitiated Vata. As per Charaka, Yashtimadhu is a Dravya mentioned under Shonithasthaapana Gana. Moreover Yashtimadhu is a Medhya Rasayana Dravya. Ghritha is also known as Paramaushadi for Pitta. Along with this Ghritha has Deepana-Pachana property which helps in restoring the Agni eventually leading to the cure of the disease. As per Charaka, Ghritha possess unique property called ‗Samskaarasya Anuvarthanaath‘, i.e. it enhances the quality of the drug with which it is processed with. So when Yashtimadhu is processed in Ghritha which is also of Madhura Rasa, Sheetha Veerya, Guru, Snigdha Guna and Vata-Pittahara Karma, the quality of our drug on treating Pandu is enhanced in total.

Yashtimadhu Ghritha being Snehana, Deepana, Balya and Ojasya in nature, it can be concluded that it is clinically effective in treating Vatadhikya Panduroga.

1) Vaidya Yadavji Trikamji Achaarya edited Sushrutha Samhitha of Acharya Sushrutha, with Ayurveda Dipika Commentary of Chakrapanidatta, Sutra sthaana, Chapter Number-15, Shloka Number-5, Reprint Edition 2005, Published by ChaukambaSanskrit Samsthaan, Varanasi. 2) https://pubmed.ncbi.nlm.nih.gov/10746344/ 3) Savils. Savill‘s System of Clinical Medicine, 14th ed. London, Edward Arnold Publishers; 1964. p. 813 4) Kawaljit K. Anaemia ‗a silent killer‘ among women in India: Present scenario. European 5) Malhotra P, Kumari S, Kumar R, Varma S. Prevalence of anaemia in adult rural population of North India. Journal of the Association of Physicians of India Jan 2004;52: 18-20 6) National Family Health Survey (NFHS-III), 2005-2006, http://www.nfhsindia.org/pdf/India.pdf, last accessed on 4th February, 2014. 7) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha of Acharya Agnivesha, with Ayurveda Dipika Commentary of Chakrapanidatta, Chikitsa Sthaana, Chapter Number-16, Shloka Number-39-40, Reprint Edition 2016, Published by Chaukamba Surbharathi Prakashan, Varanasi, Page Number-528

Post Graduate Scholar, Department of Kayachikitsa, K.V.G. Ayurveda Medical College, Sullia, Karnataka, India draparnagsreejith@gmail.com