Anaemia (Pandu) Written by Sheetal Katoch

Anaemia

Anaemia referes to a state in which the level of haemoglobin in the blood is below the normal range appropriate for age and sex. Other factors including pregnancy and attitude, also affect haemoglobin levels and must be taken into account when considering whethere an individual is anaemic.

Adult reference ranges for RBCS*
Male Female
1. Haemoglobin (g/dl)                 13-18          11.5 – 16.5
2. PCV (%)                               .40 - .54      .37 – .47
3. MCV (fl)                                78 – 98
4. Red cell count 106/mm3         4.5 – 6.5         3.8 – 5.8
5. Mean cell haemoglobin (pg)    27-32
* Reference ranges vary among laboratories. The refrences ranges for the laboratory providing the result should always be used in interpreting the test result.

The clinical features of anaemia reflect diminished oxygen supply to the tissue and depend upon the degree of anaemia, the rapidity of its development and the presence of cardiorespiratory disease.

Classification

A) Pathophysiologic classification :-
I Anaemia due to increased blood loss

• Acute post haemorrhagic anaemia
• Chronic blood los

II Anaemia due to impaired cell production
a) Cytoplasmic maturation defects

• Deficient Haemsynthesis – Iron deficiency anaemia
• Deficient globin synthesis – Thalassaemic syndrome

b) Nuclear maturation defects

• Vit B12/folic acid deficiency – Megaloblastic anaemia

c) Defect in stem cell proliferation and differentiation

• Aplastic anaemia
• Pure red cell aplasia

III Anaemia due to increased red cell destruction (hemolytic anaemias)

• Extrinsic (extra corpuscular) red cell abnormalities.
• Intrinsic (intra corpuscular) red cell abnormalities.

B) Morphologic Classification

1. Microcytic, Hypochromic
2. Normocytic, normochromic
3. Macrocytic, normochromic

Treatment

1. The patient of pandu roga (anemia) after unction should be subjected to strong emesis and purgation.
A) For unction following ghrita are used
Charaka Samhita

• Panchgavya ghrita
• Mahatikta ghrita
• Kalyanaka Ghrita
• Dadimadya Ghrita
• Katukadya ghrita
• Pathya Ghrita
• Danti Ghrita
• Draksa Ghrita
• Haridra Ghrita
• Buffalow’s ghee 640 g cooked with cow’s urine in double quantity of ghee with the paste of daruharidra.

B) After administering the above uncting preparations the patietn is considered as uncted sufficiently he should be purged by giving.

• Milk mixed with cow’s urine.
• Milk in profuse quantity.
• Decoction of danti fruits hot infusion of Kasmarya or grape fruits 160g.
• Trivrit powder 20g mixed with sugar in double quantity.
• Haritaki fruits dipped in cow’s urine along with the same.

After evacuation of dosha patient should be managed with wholesome diet such as old Shali rice, barley and wheat with soups of green gram, pigeon pea and lentils or meat soup of wild animals and birds.

2. Use of Cow’s urine in anaemia

A) Cow’s urine & Haritaki use
Haritaki may be taken regularly with cow’s urine after the drug is digested the patient should take food with milk or sweet meat soup.
B) Cow’s urine use

• Cow’s milk mixed with urine of cow or buffalow for fortnight.
• Decoction of triphala mixed with cow’s urine for a week.

Formulations

A) Charaka Samhita

• Navayasa powder
• Manduravataka
• Swarna makshika yoga
• Yogaraja
• Shilajatu vataka
• Punarnava mandura
• Dhatryavaleha
• Mandura vataka
• Gauda arista
• Bijakarista
• Dhatryarista

B) Sushruta Samhita

• Brihatyadi ghrita
• Yashti powder ( Churna)
• Triphla powder
• Ajashakridadi Churna
• Manduradi prayoga
• Vibhitakadi Vataka
• Soverchaladi yoga
• Blashigru yoga
• Nygrodhadi varga decoction
• Vidangyadi avleha

4. Treatment of Panduroga due to ingestion of mud/soil

Firstly, the ingested earth (mud) should be eliminated by administering strong evacuative according to strength. There after when the body gets cleansed the strength – promoting Ghritas should be administered.

On suffering from the ailments of the earth eating should take ghee cooked with Trikatu, Bilwa, Haridra, Daruharidra, Triphala, two types of Punarnava, Musta, Lauhabhasma, Patha, Vidrigandht, Devadaru, Bharangi and Yavaksara all in equal quantity. Like wise, he should take Ghee cooked with Nagkesara, madhuyasti, Pippali, Yavaksara and Durva.

If the patient does not resist from eating due to greediness, the earth should be given to him amply impregnated with drugs which distroy its harmful effect such as Vidanga, Ela, Ativisa, Nimbha leaves, patha, Bhahati (fruits), Katurohini, Indrayava or Murva.

Pathya - Apathya

A) Pathya

• Old Shali rice
• Old barley
• Old wheat
• Soups of green gram, pigeon pea, lentils
• Meat soup of wild animals and birds (desert animals, birds)

B) Apathya

a) Ahara

• Sour, saltly and strong irritant food items
• Incompatible and unsuitable food.
• Black gram
• Tila
• Oil

b) Vihara (proposed life style modification)

• Day sleep
• Exercise
• Alcohol intake
• Smoking
• Suppression of natural urge to vomit out.
• Mud or soil eating
• Polluted water
• Avoid anger