Pāṇḍuroga (anemia) according to Caraka

The dhātus in the human body are affected by the pitta doṣas. Then the dhātus lose their effectiveness. Then these doṣas pollute the minerals in the body and the colour of the body changes. The body loses strength, sneha, Oja and other important things. Through this the patient loses red blood cells, fat, immunity, and the ability of the five senses. Thus, the patient is affected by Pāṇḍuroga. Alkali, Āmlā, salt, atyuṣṇa, viruddha, bad diet, śimbī, māṣakalāṣa, tilakalka, tila, mustard oil should be consumed every day. Due to Grahaṇī doṣa and other reasons one gets indigestion, the need to sleep during the day, laziness, lustfulness, disbalance of pañcakarma, suppression of natural urges, anxiety, the heart is affected by rage and sorrow. Due to these reasons pitta in the heart is aggravated. The strong wind in the body gets disrupted and affects the ten dhamanīs in the heart and this spreads throughout the body. The blood and air in the skin and flesh of the human body are infected by this kapha. The skin and flesh are also infected. Consequently, the colour of our skin changes to pāṇḍu, hāridra, harita and different colours. This is called Pāṇḍuroga or Anemia. The pre-symptoms of Pāṇḍuroga are increased heartbeat, dryness, lack of perspiration and enervation. The general symptoms of Pāṇḍuroga are ear pain, pain in pancreas, weakness, depression, insomnia, laziness, hallucination, body ache, fever, breathlessness, lack of appetite, rage, somnolence, pain in foot and thigh etc.

Pāṇḍuroga is of five types—

1. Vātaja,
2. Pittaja,
3. Kaphaja,
4. Sannipātaja and
5. desire to consume soil^[1].

Dr. Udaychand has said that soil-consumption related Pāṇḍuroga is like chlorosis. Ślaiṣmika is a symptom of Pāṇḍuroga like anemia. Vāta-Pittaja is a symptom of like jaundice. Vaidyācārya Kalikinkara Sensharma and Āyurvedācārya Satyasekhar Bhattacharya are of the opinion that the soil consumers have the infection in their air pitta kapha aggravated. Once this happens no other disease but Pāṇḍuroga affects a person. For this, soil has been mentioned. According to Ācārya Suśruta it is so called because of pāṇḍutā. But here in addition to pāṇḍu other colours are also present. Due to bad diet and habits, the air in our bodies is infected and it causes Vātaja-Pāṇḍuroga. Due to this the skin becomes dry and dark. Also, Aṅgamarda, fever, toda, kampa, back pain, headache, enervation etc., occurs. Ācārya Gaṅgādhara does not mention Kṛṣṇa in his book but it is mentioned in the book Bhāvaprakāśa. Pittaja diet and habits the pitta in our bodies is infected and it causes pollution in the minerals in our blood and causes Pittaja-Pāṇḍuroga. In pitta affected Pāṇḍuroga, the patient’s skin colour turns pitta or harita and fever, vomiting, drowsiness, thirst, yellow excretion (both solid and liquid) occurs.

Śleṣmaja habits and diet infects the mucus in our bodies, and it causes Kaphaja-Pāṇḍuroga. In this disease the body experiences, drowsiness, nausea, listlessness, breathing problems, cough, laziness, lack of appetite is observed. Diet that causes the body to increase the air, pitta and mucus in our bodies aggravates three doṣas in our bodies. Then Sānnipātika-Pāṇḍuroga is caused. The men who have a habit of consuming soil will have one of the three doṣas neutralized. For example, if a person eats soil enriched with kaṣāya rasa then he experiences flatulence. The one who eats ūṣara soil gets pitta doṣa. The one who eats soil enriched with sweet rasa will have kapha doṣa aggravated. Due to this reason the strength, effectiveness, Oja and vīrya of the five senses is negatively affected. And strength, colour and agni-nāśaka cause Pāṇḍuroga. The Pāṇḍuroga that is caused by the erosion of soil results in worms inside stomach. Śotha occurs in throat, pupil, eyebrows, navel, liṅga and legs.

For the Pāṇḍuroga patient who excessively ingests pitta enriched victuals will have his pitta polluted which will infect his flesh and blood. This causes Kāmalāroga. Kāmalāroga causes the eyes, skin, nails, and mouth to turn inordinately yellow. Blood is released with human excreta and it turns pittavarṇa. Spotted marks appear all over the skin. The symptoms of Kāmalāroga are dāha, indigestion, weakness, despondency, lack of appetite, loss of perception through sense organs. Kāmalāroga is caused by many pittas. Kāmalāroga is of two types’ koṣṭha-śākhāśrita (located in belly) and śākhāśrita (located in periphery). Kāmalāroga is not cured for many days, so the minerals of the body are lost and it leads to kuṣṭhasādhya kumbhakāmalā-roga. For the Kāmalāroga, patients whose excreta and eyes turn black and also suffer from oedema, the patient is liable to die quickly. Five instances of Pāṇḍuroga are incurable; if the Pāṇḍuroga has endured for a considerable length of time, if the minerals in the patient’s body dries up, if the Pāṇḍuroga has not been cured for some time, if oedema becomes a symptom, if all the substances of the patient turns pitta, the patient whose mucus is yellow and whose excrement is little and dry, the patient who is poor and whose skin is white, whose body seems smeared with some paste, the one who is vomiting, is enervated, suffers from extreme thirst, whose blood is thinned, whose blood turns white, in all these instances the Pāṇḍuroga is incurable.

For general treatment of Kāmalāroga and Pāṇḍuroga, the following may be practiced. The patient suffering from Pāṇḍuroga should be given emetic and purgation therapies with unctuous and hard drugs for the purging the patient’s body. Again, the patient suffering from Kāmalāroga should be given purgation therapy with mild and bitter drugs. Once the patient’s Koṣṭha subsides, both maladies can be treated with the following medicines: old Śāli type rice, barley and wheat mixed with yūṣa (vegetable soup) of Mudga, āḍhakī and Masūra and meat soup of animals living in arid zones. For oleation therapy, the patient suffering from pāṇḍu and kāmalā should be given Pañcagavya-ghṛta, mahātikta-ghṛta and kalyāṇaka-ghṛta.

Other than this, in both maladies, different blended drugs are used like dāḍimādya-ghṛta, kaṭukādi-ghṛta, pathya-ghṛta, dantī-ghṛta, drākṣā-ghṛta, haridrādi-ghṛta etc. Haridrādi-ghṛta [ghṛtaṃ] means Haridrā, Triphalā, Nimba, Beḍelā, Yaṣṭimadhu. The mixtures of these are taken one ser, māhiṣa-ghṛta four ser, milk sixteen ser. These then should be mixed together and the medicine is prepared. This ghṛta is an excellent curative for jaundice.

Other purgative therapies and other medicines can be used to treat these two diseases, like boiling Harītakī immersed in cow urine and drinking it with cow urine. This can cure kapha-Pāṇḍuroga. Trikaṭu-powder must be consumed with paste of Bilva-patra. This neutralizes Kāmalāroga.

The patient afflicted with Pāṇḍuroga must undertake a treatment process lasting a week where he must consume Harītakī with cow urine and after digesting this he should have meals with milk or saccharin added with meat soup. Iron powder should be made to absorb cow urine for seven nights. The doctor should administer this decoction with milk for lessening the effects of Pāṇḍuroga. One part of each of the powders of Śuṇṭhi, Pippalī, Marica, Harītakī, Bibhītaka, Āmalakī, Musta, Viḍaṅga and Citraka and nine parts of the powder of iron should be mixed together. Ingesting this concoction with ghee and honey cures anemia, cardiac maladies, and problematic epidermal diseases like leprosy, piles and jaundice. This recipe was given by Kṛṣṇātreya who is also known as navāyasa-cūrṇa.

Regarding the liquid diet of Pāṇḍuroga patients it has been said: Pañcamūla boiled water and food is good for the patient, for Kāmalāroga patients, raisin and Āmlā juice should be given. For the treatment of the patient of Pāṇḍuroga the following medicines should be used: when the pāṇḍu is of vātika type the therapy should be dominated by unctuous medicines like oil, ghee etc. when the pāṇḍu is a Paittika type medication should be dominated by bitter and cooling drugs. For Kaphaja pāṇḍu pungent, bitter and hot drugs should be used. For Sānnipātika pāṇḍu all the medication mentioned above must be blended together.

Soil consuming Pāṇḍuroga patient are treated by physician depending on how well they can accept the treatment. Through sharp medication the physician cleanses the patient’s body of soil. After this process patient is administered various types of medicated ghee like—vyoṣādya-ghṛta for boosting his strength. If the patient doses not cease consuming soil then drugs like Viḍaṅga, Elā, Ativiṣa, and Nimba should be mixed with the mud. In śākhāśrita kāmalā the stool is like sesame paste, white in colour because of stoppage of Pitta by impaired Kapha. To remove this obstruction the physician prescribes hot spicy medicine to bring pitta from Śākhā to the intestine. In Halīmaka Vāta and Pitta colour of persons skin changes to yellow, blue or green. The treatment is done with the following: Oleation with buffalo milk, ghee mixed with guḍūcī juice and milk; Agastya Harītakī; cleansing with Āmlā juice mixed with niśotha powder. After this the patient is given diet rich in sweet taste which causes Vāta and Pitta^[2].

Footnotes and references:

[1]:

pāṇḍurogāḥ smṛtāḥ pañca vātapittakaphai straya: |
caturthaḥ sannipātena pañcamo bhakṣaṇānmṛdaḥ || (C. Cikitsāsthāna–XVI.3); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. IV, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 81.

[2]:

C. Cikitsāsthāna–XX.2-68; Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka-Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 553-567.