International Journal of Medical Science and Clinical Inventions

Volume 2 issue 02 2015 page no. 751-760 ISSN: 2348-991X

Available Online At: http://valleyinternational.net/index.php/our-jou/ijmsci

A Profile on Medico-Historical Aspects Of Anaemia In

Ayurveda
Dr.Vedantam Giridhar
Dr.Vedantam Giridhar, Assistant Professor, Department of Dravyaguna, KLEU’S Shri
B.M.Kankanwadi Ayurveda Mahavidyalaya, Shahapur, Belgaum- 590003, Karnataka, India.
Corresponding Author: Dr.Vedantam Giridhar, E-mail: drgiridharay@gmail.com

Abstract:
Anaemia (Pandu) has been well discussed in Ayurveda since ancient times. Rigveda mentions it and
Atharva Veda finds the relation with Ayas ie Iron. Charaka, Susruta, Harita and Bhela etc described its
management in detail. Various aspects of Pandu like diagnosis, food related, life style related,
psychological, disease related Etiology, types, pathogenesis, prodromal symptoms, clinical signs and
symptoms, prognosis, clinical management, complications, dietary & other regulations described by
different Acharyas from ancient, medieval and recent times were discussed in chronological order. Attempt
was made to highlight contribution of them specific to anemia management. This will be relevant now
because of prevalence of anemia in our country. Ayurveda will support the strategies to improve Quality of
life of people by its principles.
Key words: Pandu, Anemia, Evolution of Ayurveda, historical profile

Introduction:
Anaemia is one of the common disease deficiency, protein deficiency, blood loss due
affecting all the people of different backgrounds common conditions like haemorrhoids, ulcers,
such as country, income, age, gender etc. It is accidents, surgery, menstrual loss, delivery etc.,
prevalent in all groups of people. Because of its different diseases , various drugs specially
widespread nature, it is still an important disease in anticancer drugs, genetic disorders like
public health management. Due to its multifactor Thalassemia, sickle cell disease etc. Among them
etiology it affects all. Its etiology includes nutritional (vitamin B12, folic acid, Iron and
nutritional causes like macronutrient (Iron) Protein) deficiency either primary or secondary, is

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the foremost reason for anaemia, followed by blood In Kasyapa samhita clinical features of
loss and other disorders, in India and world wide. Pandu were explained in Sutra sthana 25th chapter
Detailed references are found about Anaemia in named Vedanadhyaya. But Cikitsa chapter is
Ayurveda.from Rigvedic period to recent times. missing.
Researches are still conducted to understand its In Bhela samhita cikitsa sthan 25th chapter
multifaceted etiopathology and its management to named Pleeha Halimak Cikitsa, some treatments
suit the needs of current situation globally. were described. But total description was missing.
Astanga Sangraha and Astanga Hrdaya
In Rigveda references are found with terms
explain nidana in in 13th chapter of nidana sthana.
like Harima / Halima and Vilohita. Harima means
Pandu cikitsa is described in 18th chapter of Astanga
yellowish discolouration which denote jaundice
Sangraha and 16th chapter of Astanga Hridaya.
(Kamala) and Anaemia (Pandu). Vilohita refers
Madhavanidana describes
condition of blood loss. Atharva Veda mentions
etiopathology in 8th chapter. Bhaprakasha explains
these diseases and even describes treatment with
its nidan and cikitsa in madhyama Khanda as
Iron (Aya). References of Pandu or anemia are
Panduroga kamala Halimakadhikara. Its description
found in Mahabharata, where king Pandu born with
is found in various sangraha texts too.
pallor. In Agnipurana and Garuda Purana
Pandu roga is disease in which “Pandu”
description of Pandu is found.
varna (colour / complexion) is identifying clinical
In Ayurveda, Anaemia as a disease was
feature. ‘Sabdastoma’ explains it as svetavarna
described in detail in all samhita and sangraha texts.
(white colour), resembling the colour of pollen of
All have described the etiology, pathogenesis,
Pandanus flower (Ketaki dhuli sannibha), along
clinical features, prognosis, complications and
with yellow colour. Bhattojidikshita on Amarakosha
management of Pandu.
commentary explains it as white with yellowish
In Caraka Samhita, Cikitsasthan 16th chapter
tinge (peeta samvalita sukla). Commentators like
describes in detail about Pandu (anemia). Susruta
Cakrapani, Dalhana, Arunadutta meant it as sveta,
Samhita deals with Pandu management in Uttara
dusara, svetavabhsa and peetavabhasa. Gangadhara
Tantra 44th chapter.
describes it as Mlana varna. Caraka describe Pandu
Harita samhita describes Pandu in Tritiya
as “ Vaivarnyam bhajate atyartham” (Ca.Ci.16/6).
sthana (Cikitsa) 8th chapter. It elates it as
Vaivarnyam means discolouration. It has two
‘Mahagada’.
contexts – 1. Vigata varna (diminished colour) and

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2. Vikrita varna (abnormal colour). Palllor, paleness blackgram (masha), gingley oil and paste (tila tala
or diminished colour or whitish colour are and pinyaka) will lead to Pandu as per Caraka.
prominently found all over skin especially in eyes (Ca.Ci. 16/7).
etc. Susruta samhita includes madya (alcohol
In Pandu whitish discoloration is preparation), mrit (clay) and teekshna (highly
predominant eventhough other discolouration like irritant substances) in etiology.
yellow (haridra), harita (green) etc are also found. Haritha samhita describes Kalyamaireya
(type of alcohol preparation) consumption, intake of
Identificaton:
even katu (pungent), kashaya (astringent)
Panduroga is identified especially with the
substances as etiology of anaemia.
pallor wit other signs symptoms mentioned
Dalhana adds consumption of Pishta (flour),
Ayurveda. Whitish discolouration of skin all over
drinking only milk, fish, meat, cane sugar juice and
body is described in all texts as main identification
dry substances (ruksha) as etiology.
sign. Sveta akshi (paleness of conjunctiva) is
Eating clay or earth (Mrttika) is said as one
described in Kashyapa samhita along with pallor of
of the important reason. DushiVisha and vitiated
skin. (Kashyapa samhita sutra 25th chapter verse
water consumtion are also mentioned as Etiology.
35).
(Pandu by R.R.Pathak)

Etiology: Life style related etiology (Vihara) :

Pandu is pitta predominat disorder involved Vihara can be devided into tw types. 1.

with vitiation of all three doshas. Anaemia etiology Physical (Saririka) 2. Psychological (Manasika)

is multifactorial. Ayurvedic scholars have dealt it reasons.

elaborately. Principally etiology is of 3 types viz. 1.

Physical :
Ahara (food / nutritional) 2. Vihara (life style) and
Sleeping during day time (divasvapna),
3. Nidanathakara roga (produced by other diseases).
exercise (vyayama) and sex (vyavaya) during time
of digestion of food (vidagde anne), improper
Food related Etiology (Ahara):
administration of Pancakarma therapies, not
Excessive intake of alkaline (kshara), sour
following proper seasonal regimen and suppression
(amla), salty (lavana), hot (ushna), mutually
of natural urges are reasons for anemia according to
contradictory food (viruddha), unwholesome food
Caraka. (Ca.Ci. 16/8)
(asatmyabhojana), nishpava (a type of grains),

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Excessive exercise and sexual indulgence All disease where there is loss of blood viz.
are also etiology of Pandu as per Susruta. raktaipravrirtana, katika taruna marmavedha,
Kashyapa samhita describes anaemia as a raktavahidhamani vedha, raktarbuda, antarlohita,
complication of improper Oleation therapy yakrit pliha vedha (Susruta), raktapitta
(snehana) and non observance of diet mode of life complications (caraka), raktasrava (Sharangadhara
style after purificatory (shodhana) therapy. (K.S. uttara 12).
Sutra 22/49-51; 24/16-17). Consumption of sneha Other disases viz. Punaravartaka javara,
(oily substances) and anda (eggs) during Lasuna jeerna jvara (Ca.ci.), arsa (Susruta), krimi,
Kalpa therapy leads to anaemia. (K.S. Kalpa 2nd ch. asrigdara, pleehodara, yakridalyudara, dooshyodara,
73-76) raktarbuda, vyavaya sosha, sosha, pittaja pratisyaya,
Haritha samhita describes excessive walking pittaja kasa, antarmrita sisu, revatigraha, sukra
on journey (adhva), excessive work, no exercise kshaya, beejopaghata. Pittadooshya stanya, Paittika
sleeplessness etc. also as etiology of anaemia. prameha, asmari rogopadrava, mamsa
marmabhighata, sarkara, sotha, vranayama,
Psychological causes:
pakvasayagata visha, akhu visha, rajimata sarpa
Excessive desire (kama), worry (cinta), fear
damsha, raktadoshaja vikara, raktagata kapha,
(bhaaya), anger (krodha), grief (Soka) will afflict
garbha and raktaja gula etc will produce anaemia.
mind (cetas) which in turn vitiates physical dosha
(Pandu roga by RR Pathak)
like Pitta etc. to produce Pandu. (Caraka Cikitsa)
Haritha samhita also describes Cinta and Types of Pandu (Bheda):
Rodhan etc as etiology. Caraka and many other Ayurvedic texts like
Haritha, Kashyapa, Vagbhata, Madhavanidana etc
Diseases as etiology of Pandu (Nidanartha kara
mention 5 types of Pandu viz. 1. Vataja 2. Pittaja 3.
roga):
Sleshmaja 4. Sannipataja and 5. Mridbhakshanaja.
Haritha samhita describes fever (jvara),
Susruta describes 8 types of Pandu viz. 1.
bleeding (raktasrava), wound or ulcer (vrana) as one
Vataja 2. Pittaja 3. Sleshmaja 4. Sannipataja 5.
the etiology of Pandu.
Kamala 6. Kumbha 7. Lagharaka or Alasa and 8.
Kashyapa describes anaemia as a
Halimaka. In these last four are related to Pandu but
complication in Raktagulma (K.S.Cikitsa 8/18-19).
they have separate identity beyond Pandu.
Pandu is described as one of the 64 puerperal
Haritha describes Mridbhakshanaja Pandu as
complications. (K.S.Khila 11/7-13)
Rukshanaja Pandu.

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Pathogenesis (Samprapti): Vagbhata includes tastelessness beyond

Various reasons mentioned above will above features. (A.H.Ci. 13)
aggravate Pitta located in Hridaya (heart). Vata
Clinical features (Rupa) of Pandu:
propel it into ten vessels (dhamani) and circulate it Caraka describes following general clinical features
all over the body. Located between skin and of Pandu: tinnitus, suppression of digestion,
muscles, Pitta vitiates Kapha, Vata, blood, skin and weakness, prostration, hatred of food, fatigue,
muscles, as a result of which different types of giddiness, pain in the body, fever, dyspnoea,
discolouration like Pandu (white), Haridra (yellow) heaviness, tastelessness. Patient feels as if all his
and Harita (green) appear on skin. limbs are being kneaded, squeezed and churned.
When dosha especialllly Pitta aggravate in Swelling of orbits, greenish discolouration, falling
dhatus, they get afflicted resulting in their weakness of hair, loss of luster, irritability, dislike for cold,
(sithilata) and heaviness (gaurava). Followed by sleepy, excess expectoration, diminished speaking,
diminished of complexion / colour, strength, and cramps of calf muscles, pain and weakness in
ununctuousness, properties of Ojus on account of back, thighs and legs, dyspnoea on climbing up.
vitiation of dosha and dushyas. Hence the patient In Kashaypa samhita, oedema around
becomes poor in blood, fat and vitality of tissues. umbilicus, whitish discolouration of eyes,
Sense organs become weak. Discolouration appears. deformation of nails (nakha vakrata), diminished
(Caraka cikitsa) appetite, swelling of orbits are described as clinical
Cakrapan comments onOjus here as Rakta features of Pandu. (K.S. 25/34-35)
dhatu. Astanga Hridaya describes flabby body,
Prodromal Signs & Symptoms (Purvarupa): increased heart rate and exertion in addition to
Palpitation, dryness, absence of sweating above features.
and fatigue are seen initially in Pandu. (Caraka) Based on the etiology five types of Pandu
Susruta describes cracking of skin, spitting, malaise, will develop and their signs and symptoms will
liking for eating clay (Pica), swelling around eyes, depict the dosha vitiated. Sannipataja Pandu will
yellowish urine stools and indigestion as prodromal exhibit features of all three doshas.
signs and symptoms of Pandu.
Haritha samhita describes pallor of body
also as initial sign. Mridbhakshanaja Pandu:

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Habitual eating of clay aggravates one of the Susruta, Madavanidana, Yogaratnakara

three doshas. Mud of astringent taste aggravates describe following symptoms as incurable :
Vata, saline mud aggravates Pitta and Sweet mud The individual suffering from Pandu will not
aggravates Kapha. Because of dryness (Ruksha), survive if paleness appears on his teeth, nails and
Mrit causes dryness in Rasa. Undigested Mrit will eyes and who sees everything as if they are in pale
fill and obstruct the channels (srotas), afflicts and colour. (Su. Sutra 33)
diminish the strength of sense organs, luster, energy Patients of Pandu who has swelling in
and Ojus. It instantly leads to anaemia, with extremities and emaciation in central part of the
diminishing strength, colour and appetite. Swelling body and vice versa (ie swelling in center & thin
of orbits, cheeks and eye brows, oedema of legs, extremities) and has swelling of the anus, penis and
umbilicus and penis, worms in intestines, diarrhoea testes, who is very weak and looks like dead one
with blood and mucous will be seen. (Caraka will not survive.
cikitsa) Pandu patient should also be discarded if
Astanga Hridaya includes swelling of face suffers from fever and diarrhoea (Su.Uttara 44, MN,
and stools with worms and broken faeces. YR)
Haritha samhita describes severe emaciation of According to Jejjata, the chronic Pandu will
tissues (dhatu kshaya), non nourishment of blood not be cured. And even the acute Pandu will not be
and body, instant destruction of parts of life cured if the patient has swelling and sees everything
(Jivanamsa) in Mridbhkshanaja Pandu. in yellow colour.
According to Cakrapani chronic Pandu in
Prognosis (Sadhyasadhyata):
which all the tissues become rigid.
Caraka describes features of Pandu which if appear
will indicate its incurability. Pandu of chronic Complications (Upadrava):
Tastelessness, thirst, vomiting, fever,
origin, with excessive dryness, oedema due to
headache, diminished appetite oedema of throat,
chronicity of disease, objects looking yellow,
debility, fainting, exhaustion, pain in heart are
constipation and less stools, stools with mucous,
complications of Pandu as per Susruta.
green colur and loose nature, prostrated, excessive
whiteness in body, afflicted with vomitings, Halimaka:
fainting, excessive thirst, patients getting pallor due If colour the patient suffering from Pandu
to more loss of blood will not survive. becomes green, black or yellow and if he suffers
from dimunition of strength & enthusiasm,

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drowsiness, diminished appetite, mild fever, lack of formulations containing Haritaki powder mixed
libido, malaise, dyspnoea, morbid thirst, anorexia with plenty of Honey & ghee.
and giddiness, the ailment is called Halimaka, Ghee cooked with Haridra or Triphala or
caused by aggravation of Vata and Pitta. Tilvaka or some purgative drugs / formulations with
(Ca.Cikitsa) ghee are also prescribed.
Lagharaka or Alasa: Kashyapa samhita mentions in its Satapuspa
Pandu with fever, body pains, giddiness, Kapa that Satapuspa should be administered in
malaise, drowsiness and wasting are seen in this persons suffering from Pandu, Kamala etc with She-
disease. (Su.Uttara 44) buffalo milk and urine. (K.S. Kalpa 5/ 20-22). It
Panaki: also mentions Trivritastaka curnam with Pathya,
High temperature with diarrhoea, yellow Trijataka, Vyosha, Vidanga, Amalaka, Ghana - all
colour appears on external and internal organs, equal parts, mixed with sugar 6 times, Trivrit 8
paleness of eyes are seen. (Yogaratnakara) times to all, grinded together to cure anaemia. (K.S.
Khila 7/ 65-66)
Clinical Management of Pandu
Bhela Smhita describes Ayoraja (Iron
Caraka describes that in patients of Pandu of
powder) for administration along with milk as
curable nature, emetic and purgative therapies with
Rasayana in Halimaka. (Bhela samhita Cikitsa 25/
unctuous and teekshna drugs should be given for
11)
cleansing the body by eliminating the doshas.
Harita samhita mentions many preparations
After cleaning Koshta by purificatory
containing Iron for curing Pandu viz.
measures, wholesome food containing Sali (rice),
1. Loha curnadi vati - iron powder grinded with cow
barley, wheat, mixed with soup (Yusha) of
urine and administered internally along with honey.
greengram, adhaki and lentils, and soup of animals
2. Loha powder or Lohakittam mixed with Trikatu,
inhabiting arid zones.
Triphala, Trimada and grinded with Ikshurasa
Based on dosha aggravation other
(canesugar juice) and administered with honey and
medication should be given.
ghee.
For snehana (oleation) Pancagavyaghrita,
3. Mandura vati, Vajramandura vati, Amrita vati etc
Mahatiktakaghrita, Kalyanaka ghrita etc should be
were also mentioned.
given. (ca. Ci. 16/39-43)
Caraka mentions Iron preparations like
Susruta describes Urdhva & adha Shodhana
Navayasa curna, Mandura vataka, Tapyadi yoga,
with Snigdha ghrita followed by treatment with

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Yogaraja, Silajatuvataka, Punarnavadi mandura, Yogaratnakara describe some special

Manduravataka, Dhatryavaleha, Darvyavaleha, preparations like 1. Madura lavana 2. Madhu
Gudarista, Bijakarista etc. Mandura 3. Manduradyarista 4. Hamsa Mandura 5.
It also mentions Iron powder impregnated Mathebha simhasuta rasa etc for anaemia
with cow’s urine for 7 nights administered along management.
with milk. In Bhaisajyaratnavali following important
Haritaki along with cow urine for 7 days formulae were mentioned
followed by food with milk or sweetened meat soup - Gudaharitaki
after digestion of medicine is also prescribed in - Milk boiled in Iron vessels is advised for drinking.
Caralka. - 1. Tiladi modaka 2. Trikatrayaloha 3.
Susruta mentions : Pancamrutalohamanduraa 4. Candrasuryatmaka
. Loharaja with Trikatu, Vidanga mixed with ghee rasa 5. Pranavallabha rasa 6. Punarnavadi tailam
& honey 7. Parpatadyarista 8. Lauhasava etc
- Haridra & Triphala mixed with honey & ghee Kashyapa samhita mentions that in anaemia
- wholesome diet with juice of Amalki fruits or purgation (Virecana) with overunctuous
sugarcane juice or honey (atisnigdha) diet/ drugs is prohibited (K.S.Khila
- Triphala pulp with lauha curna with Pravala, 7/27-28)
Mukta, Anjan curna etc. Sveda karma (Sudation therapy) is
Astanga Sangraha describes Iron (Ayoraja) prohibited in Pandu roga.
as the top medicinefor curing Anaemia (Pandu)
Pathya & Apathya :
(A.S. Su. 13/2) Harita samhita describes compatible food
Vrindamadhava mentions: for anaemia as wheat, rice, barley, greengram,
- Goat milk cooked Bijapura roots along with adhaki, ghee, milk, buttermilk, Gandiva, Vastuka
purified Saileya (bitumen) for Vataja Pandu (Chenopodium), fennel and Meat of Jangala
- Two parts of sugar +one part of Trivrit in a dose animals.
of half Pala for Pittaja Pandu Apathya are bitter, dry, pungent, teekshna,
- Decoction of Dasamula and sunthi for Kaphaja hot substances, Kanjika, Sura, Aml, Sauviraka,
Pandu (Alcohoic preparations), Bijapura, Taila (oil).
- Loha preparations along with buttermilk (Takra) Vrindamadhava also mentions above as
as adjuvant (anupana) pathya.

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Yogaratnakara mentions Masura also as Hyderabad for support. Author also thank Principal,
pathya. In apathya it includes fire, sun exposure, KLEU’s B.M.K. Ayurveda Mahavidyalaya for
exercise, Pittaja food, sex, anger and journey. encouragement throughout. I also thank Dr
Kashyapa mentions that meat soup and Bhuvnesh Kumar Sharma, Asst. Director, CCRAS
canesugar juice are contraindicated in anaemia. Unit, Jaipur, for his guiding.

Research References:
Research was conducted in all Ayurvedic institutes 1. R.K. Sharma, Bhagvan Das; Caraka Samhita;
in their PG and doctoral research.
Chowkhambha Sanskrit Series office, Varanasi,
Special projects were conducted regarding anaemia 2007.
research. Two books Viz Anaemia in Ayurveda By 2. Susruta samhita, Chowkhambha Sanskrit Series
Mehta and Panduroga By Ram Raksha Pathak were office, Varanasi, 2007.
published based on Pandu research. Nutritional 3. K.R. Srikantha Murthy; Asstanga Sangraha,
research supported Ayurvedic line of management. Chaukhambha Orientalia, Varanasi, 9th Ed.,
Discussion & Conclusion 2005/2007.
Pandu is still one of the disease condition affecting 4. K.R. Srikantha Murthy; Asstanga Hridaya,
millions of people in India as well globally. Chaukhambha Krishnadas Academy, Varanasi,
Women, children and old people are more affected. 2006
Multiple etiological factors including under- 5. P.V.Tiwari, Kashyapa samhita, Chaukhambha
nutrition especially of protein, Iron etc, intestinal Visvabharati, Varanasi, 2002
infestations, haemorrhoids, pregnancy etc. leading 6. A.H. Krishnamurthy; Bhela Samhita,
for more cases of anemia. It is a major concern of Chaukhambha Visvabharati, Varanasi, 2006
public health strategies of country. Management of 7. hariprasad Tripathi; Harita samhita;
anemia will help in Quality of Life and increase the Chaukhambha Krishnadas Academy, Varanasi,
healthy working conditions. 2005.
Ayurveda through its comprehensive approach will 8. Premvati Tiwari; Vrndamadhava; Chaukhambha
help the society in managing this thus promote the Visvabharati, Varanasi, 2006
public health. 9. M.S.Suresh babu; Yogaratnakara; Chowkhambha
Acknowledgement: Sanskrit Series office, Varanasi, 2005.
Author is thankful to Director and staff of National
Institute of Indian Medical Heritage, CCRAS,

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10. Gyanendra Pandey; Bhaisajya Ratnavali,

Chowkhambha Sanskrit Series office, Varanasi,
2007
11. P. Himasagaracandra Murthy; Madhava
niddana, Chowkhambha Sanskrit Series office,
Varanasi, 2006
12. Venkata Sastry, Bhavaprakasa, Vavilla Rama
sastrulu & Co. Chennai
13. Ram Raksha Pathak; Panduroga; Kendriya
Ayurvedanveshan samstha, Jamnagar
14. Ranajit Rai Desai; Nidan Cikitsa hastamalak,
Chaukhambha , Varanasi

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