Critical Review on Beeja Doshaj Pandu Roga in Bala Roga w.s.r. to Thalassemia

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ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2019 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2019 | Vol. 4 | Issue 1 69 Critical Review on Beeja Doshaj Pandu Roga in Bala Roga w.s.r. to Thalassemia Dr. Avinash Karambhe, 1 Dr. S. K. Danga, 2 Dr. Chetan Gulhane. 3 1 Assistant Professor, Dept. of Kaumarbhrutya, B. M. Ayurveda Mahavidyalaya, Nagpur, Maharashtra, 2 M.D. Kayachikitsa, MPH, Nagpur, Maharashtra, 3 M.D., Ph.D. Panchakarma, IPGTRA, Jamanagar, Gujarat, INDIA. I NTRODUCTION Thalassemia is one of the major health problems which affect a large number of individuals worldwide. 7% of the worldwide population being carriers, hemoglobinopathies are the most common monogenic diseases and one of the world’s major health problems. They were originally found mainly in the Mediterranean area and large parts of Asia and Africa [1] Thalassemia is not a disease of “just a few people”. Almost 25 million people in India are carriers of thalassemia gene [2] Thalassemia is classified Address for correspondence: Dr. Avinash Karambhe Assistant Professor, Dept. of Kaumarbhrutya, B. M. Ayurveda Mahavidyalaya, Nagpur, Maharashtra, India. E-mail: sunder 147@gmail.com Submission Date : 27/12/2018 Accepted Date: 19/01/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.4.1.14 according to the affected globin chain, i.e. α- thalassemia and β-thalassemia. α -thalassemia is caused by a decrease in production of α -globin chains due to a deletion or mutation of one or more of the four alpha globin genes located in the short arm of chromosome 16, whereas β thalassemia is caused by mutation of β-globin gene located on chromosome 11 [3] The clinical severity varies widely, depending on the degree to which the synthesis of the affected globin is impaired, altered synthesis of other globin chains and co-inheritance of other abnormal globin alleles. Children born with thalassemia major usually develops severe anaemia, ineffective erythropoesis, jaundice and haemosiderosis which results in greenish brown complexion and suffer from retarded physical growth, poor feed, hepatosplenomegaly, irregular fever due to increase metabolic activity or intercurrent infection. Increased nutrition demand results in cachexia, fatigue etc. In Ayurveda, Beeja Doshaja Pandu can be correlated with Thelassemia, on the basis of etiopathogenesis of the disease and can be interpreted by the application of methodology A B S T R A C T Thalassemia syndromes are most common single gene disorder in the world and represent a major health burden worldwide. It is a heterogeneous disorder recessively inherited resulting from various mutations of the genes which code for globin chains of Hb leading to reduced or absent synthesis of globin chains. In Ayurveda, Aacharya Charaka described Beeja Dushti Janya Vikaara . He explained that specific Avayava would be Vikrita , if Doshas vitiate specific Beeja or Beejabhaaga . Scientists are working to remove excess iron in order to prevent or delay iron overload which is achieved by prolonging blood transfusion interval and searching effective, orally administrable, economical iron chelators to combat the Thalassemia. In Ayurveda Raktashodhana , Raktaprasaadana , Shonitasthaapana , Rasayana, Balya and Varnya properties decrease the rapid destruction of RBCs and thus prolonging the Life span of RBCs which increases the interval of blood transfusion. All these factors increase the expectancy of good life of Thalassemic patients. Key words: Panduroga, Bala Roga, Thalassemia, Beeja Dosha.

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[Find the meaning and references behind the names: Green, Ritu]

Dr. Avinash Karambhe et.al. Critical Review on Beeja Doshaj Pandu Roga in Bala Roga ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2019 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2019 | Vol. 4 | Issue 1 70 described by Acharya Charaka in Vimanasthana in context of Anukta Vyadhi [4] Thalassemia Major being an incurable disease, improvement in the quality of life of the patient, minimizing the complications of the disease, as well as increasing the life span should be given due emphasis, Ayurvedic drugs improve the quality of life; maintain the patient fit for curative therapies like bone marrow transplant and stem cell therapy Saamanya Nidaana of Pandu [5] Excessive intake of alkaline, sour, saline, hot and mutually contradictory food, unwholesome food, Nishpaava, Maasha, Pinyaaka and Tilataila . Sleeping during day time and exercise as well as sexual intercourse even before the food is not properly digested. Improper administration of Panchakarma therapies and transgression of prescribed seasonal regimens ( Ritu Vaishamya ). Suppression of natural urges. Addicted to eating clay or salts. Person with his mind afflicted with passion, worry, fear, anger and grief. Samaanya Lakshana [6],[7] Karnakshweda (tinnitus) Hataanala (suppression of the power of digestion) Durbala (weakness) Sadana (prostration) Annadwit (repugnance against food) Shrama (fatigue) Bhrama (giddiness) Gaatrashoola (pain in the body) Jwara (fever) Shwaasa (dyspnoea) Gaurava (heaviness) Aruchi (anorexia) Mrudita Peedita Unmathita Gaaatra (feels as if all the limbs of his body are being kneaded, squeezed and churned) Shoonaakshikoota (swelling of the orbital region) Harita (green complexion) Sheernaloma (falling of skin hair) Hataprabha (loss of luster) Kopana (irritable) Shishiradweshee (dislikes cold) Nidraalu (oversleep) Stheevana (more spitting) Alpavaak (avoid speaking) Pindikodweshtana (cramps in calf muscles) Aarohanaaayaase Kati - Uru - Paada Rook Sadana (while making efforts for climbing, he suffers from pain and weakness in the lumber region, thighs and feet). Concept of Beeja , Beeja Bhaaga and Beejabhaaga Avayava [8],[9] Beeja which is responsible for the formation of Rakta Dhaatu should include Sperm, Ovum and zygote. The chromosome 16 and chromosome 11 can be taken as Beejabhaaga which are accountable for the formation of Rakta Dhaatu . The gene locus on the short arm of chromosome 16 also called as gene cluster (30 kbp of DNA) and it consists of α and ζ genes and some pseudo genes and the gene locus located on chromosome 11 also called as β gene cluster (50 kbp of DNA), includes the embryonic globin gene, epsilon (ε), the fetal globin gene (γ) and two adult globins genes and genes can be considered as Beejabhaagaavayava responsible for the formation of Rakta Dhaatu. DISCUSSION Ayurvedic Etiopathogenesis of Thalassemia There is no one-to-one correlation for Thalassemia in Ayurveda. Acharyas have described various Sahaja Vyaadhis like Prameha , Arsha and Kushtha which

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[Find the meaning and references behind the names: Main, Daiva, Mala, Rasa, Ama, Red, Mana]

Dr. Avinash Karambhe et.al. Critical Review on Beeja Doshaj Pandu Roga in Bala Roga ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2019 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2019 | Vol. 4 | Issue 1 71 occurred due to Upatapti of Beeja , Beejabhaaga and Beejabhaagaavayava . These Sahaja Vyaadhis are Asaadhya in nature. This shows Acharyas were well acquainted with the science of genetics and they were knowing the genetical basis of these diseases. The causative factor of these diseases is defected mutation but the reason behind these mutations is not known till date. Acharyas described possible cause of Beejadushti (defected mutation) in the form of Maatru-Pitru Apachaara, Daiva, Poorvakrita Ashubha Karma and Prakopa of Vaataadi Dosha . They have also indicated the possible consequences in the form of Tridosha Prakopa, Vikrita Avayava formation corresponding to biochemical abnormalities or functional abnormalities and structural defects related to Upatapti of Beeja or Beejabhaaga . Methodology of understanding a disease process is explained by Acharya Charaka based on Aaptopadesha Pramaana . On that base, this study has been done to know the etiopathogenesis of Thalassemia according to Ayurvedic perspective. The disease process can be sequenced as: Upatapti of Beejabhaagaavayava - Mutation in Globin gene locus [10] o Mutation at β- globin locus (more than 200 mutations) o Mutations at α-globin locus (more than 30 deletion mutations) Vamshaanugatatva (Transmission in the Siblings) The Sampraapti of the disease in affected individuals Thus, here in the case of thalassemia the Upatapti of Beejabhaagaavayava is the main cause and consequent Vishamaavasthaa of Dosha , Dhatu and Mala which can lead to Lakshanas of Tridosha Prakopa . Thalassemia is an incurable disease. The patient dies due to various complications of the disease as well as the adverse effects of available medicaments. Samprapti Vivechana In the red cell precursors, due to globin gene mutation at the Beeja level, there will be Rakta Dhaatwaagni Dushti which led to Vikrita and decreased Rakta Dhaatu Nirmaana (decreased hemoglobin synthesis) [11] This severely affects the Poshana and Nirmaana of Uttarottara Dhaatu. Acharya Harita has stated that Rasa Dhaatu is converted into Rakta Dhaatu in seven days by getting new colour each day. Rasa gets Laakshaarasa Varna on seventh day. But due to Rakta Dhaatwaagni Dushti it doesn’t get proper coloured. Thus it leads to formation of Malaroopa Rakta Dhaatu which is unable to carry out the physiological functions attributed to it. Paachana of such Malaroopa Rakta Dhaatu leads to formation of Aama . Along with all these factors and Tridoshaprakopa result in the Oja Kshaya and ultimately lead to the clinical features of thalassemia Sampraapti Ghataka Dosha : Tridosha (Mainly Vaata and Pitta ) Dushya : Sarva Dhaatu, Upadhaatu and Malas Agni : Jatharaagnimaandya and Dhaatwaagni Maandya Srotas : Sarvasrotas ( Rasavaha, Raktavaha mainly) Srotodushti : Sanga Udbhavasthaana : Beeja, Aamaashaya Adhishthaana : Shareera, Mana Vyaktasthaana : Twak Rogamaarga : Baahya Management of thalassemia in Ayurveda The basic cause of the disease is Beejadushti , with grave consequences like Agnimaandya (both Jatharaagni and Dhaatwaagni ), Paandutaa , Nissaarataa and Kshaya of the Dhaatus . The consequent Tridosha Prakopa, Aama generation (free radical), along with Dhaatukshaya complicates the overall outcome of the disease. The modern medical management appears to have various short comings like lack of potent antioxidant, hepatosplenoprotective drugs and effective iron chelators without side effects. Thus to improve the quality of life, to maintain the patient fit for curative therapies like

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Dr. Avinash Karambhe et.al. Critical Review on Beeja Doshaj Pandu Roga in Bala Roga ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2019 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2019 | Vol. 4 | Issue 1 72 bone marrow transplant a lot can be done by using various drugs which are having properties like, Aamapaachana, Srotovishodhana, Balya, Pittasaaraka, Lohashodhana, Lohamaarana, Raktashodhana, Raktaprasaadana, Shonitasthaapana and Rasaayana . Some of the Dravyas that can be useful as iron chelators which are mentioned in our classics as Apathya during Lohasevana, Lohashodhana Gana, Lohamaarana Gana, Lohasevanajanya Vikaara. CONCLUSION There is no exact correlation for Thalassemia in Ayurveda. Acharyas described Sahaja Vyaadhis like Arsha, Prameha and Kushtha which shows they were well acquainted with the science of genetics. They indicated various Hetus for Upatapti of Beeja , Beejabhaaga and Beejabhaagaavayava which are responsible for organogenesis of Vikrita Avayava . The disease thalassemia can be named as Beejadushtijanya Pandu and Kulaja or Aanuvanshika Pandu. REFERENCES 1 Kleihauer E, Kohne E, Kulozik AE. Anomale Hämoglobine und Thalassämie-Syndrome Grundlagen und Klinik. Landsberg: Ecomed Verlagsgesellschaft; 1996. 2 Balgir, R. S. "The burden of haemoglobinopathies in India and the challenges ahead." Current Science, 2000; 1536-1547. 3 Pasternak, Jack J. An introduction to human molecular genetics: mechanisms of inherited diseases. John Wiley & Sons, 2005 4 Vaidya Yadavaji Trikamji Acharya editor, Charaka Samhita by Agnivesha, revised by Charaka and Dridhabala, Vimanasthana 4/6, Commented by Chakrapanidatta, Chaukhambha Sanskrita Samsthana, Varanasi, reprint 2004, p.no. 248 5 RK Sharma & Bhagwan Das editor, Charaka Samhita by Agnivesha, chikistasthana 16 Chowkhambha Sanskrit Series, Varanasi, Vol.2,reprint 2005, p.no. 284 6 RK Sharma & Bhagwan Das editor, Charaka Samhita by Agnivesha, chikistasthana 16 Chowkhambha Sanskrit Series, Varanasi, Vol.2,reprint 2005, p.no.285 7 Shri Satyapala Bhisangacharya editor, Kashyap Samhita of kashyapa with pandithemraj shastri commentary, uttarstana Chapter 25, Verse 35. Varanasi: Jaykrishnadas Haridas Gupta, 1953; 345 8 Vaidya Yadavaji Trikamji Acharya editor, Charaka Samhita by Agnivesha, revised by Charaka and Dridhabala, Sharirsthana 3/17, Commented by Chakrapanidatta, Chaukhambha Sanskrita Samsthana, Varanasi, reprint 2004, p.no. 315 9 Higgs, Douglas R. "The molecular basis of α- thalassemia." Cold Spring Harbor perspectives in medicine 3.1 (2013): a 011718 10 Thein, Swee Lay. "The molecular basis of β- thalassemia." Cold Spring Harbor perspectives in medicine 3.5 (2013): a 011700. 11 RK Sharma & Bhagwan Das editor, Charaka Samhita by Agnivesha, chikistasthana 15/28 Chowkhambha Sanskrit Series, Varanasi, Vol.2,reprint 2005, p.no. 265 ******************************* How to cite this article: Dr. Avinash Karambhe, Dr. S. K. Danga, Dr. Chetan Gulhane. Critical Review on Beeja Doshaj Pandu Roga in Bala Roga w.s.r. to Thalassemia. J Ayurveda Integr Med Sci 2019;1:69-72. http://dx.doi.org/10.21760/jaims.4.1.14 Source of Support: Nil, Conflict of Interest: None declared.

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