An observational study on morphological changes of Red Blood Cells in SANNIPATAJ PANDU ROGA

v Ayurveda is a unique contribution of Indian wisdom in the field of medicine, which is based on eternal, philosophical and scientific background. This science deals with the knowledge of life or else longevity can be achieved through it, so it is called the Science of Life. In a healthy state, tridosha, dhatu and mala continue to perform their natural functions, hence they have been called the root cause of the body. Vata, Pitta, Kapha are the basic functional factors of the body and are responsible to sustain life in their homeostatic state. The function of the above three fundamental factors is varied and manifested by certain characteristics. The normalcy of the above three factors is termed as Dhatusamya. The implied term dosha is granted as dhatu in this state.

·      Pandu has been described in detail in almost all the text of Ayurveda. The word Pandu has been derived from Padi Nashne Dhatu by adding Ku Pratyaya in it, meaning of which is always taken in sense of Nashanathat is the loss. So by the above description there is loss of bodily lusture in Pandu Roga. The disease which is predominant in paleness all over the body is termed as Pandu roga. Acharya Charak has given the term Vaivarnya for Pandu Roga. According to Acharya Sushruta, the disease in which there is predominance of pallor   in the body and body parts, is called as *Pandu.*Vachaspatya refers Pandu as the color of the patient resesmbles the color of the pollen grains of ketki flower Pandanus odoratissimuswhich is whitish yellow palein appearance.

·       Pandu roga has been described after Grahani Dosha Chikitsa by Acharya Charaka as aggravation of Pitta have predominant role in the causation of both the disease, thus Pandu Roga is a Pitta Pradhan Tridoshaj Vyadhi. Acharya Sushrut has mentioned it after Hridroga due to same Sankhya, Samprapti and Chikitsa of Hridroga like Tikshna, Alpa, Katu, etc may also cause the disease Pandu. Acharya Vagbhat described Pandu Roga after Udara Roga due to same Doshaghnata. While describing the pathological aspect of the diseases, Dhatu Pradoshaja Vikaras have been mentioned. Pandu is the disease of Rasavaha Srotas according to  Acharya Charaka and Acharya Vagbhatta and Raktavahasrotoviddha Lakshana and Rasadoshaja Vikara as per Maharshi Sushruta.

Thus it is related with both important dhatus Rasa and Rakta, Principal function of both these Dhatu has been described as Preenana (providing nourishment) & Jeevana (life activity) karma. Also due to Rakta kshaya and Ojo kshaya, there is loss of lusture and radiance and patient becomes listless. Therefore, concising Pandu Roga on the basis of only one symptom i.e. loss/change in color of skin, doesn’t seem logical. Mainly five types of Pandu have been mentioned by the Acharyas- Vataja Pandu, Pittaja Pandu, Kaphaja Pandu, Tridoshaja Pandu Sannipataja Pandu, Mridbhakshanajanya Pandu.

Acharya Sushruta has not mentioned Mridbhakshanjanya Pandu as one of the type separately but has described it under doshaj Pandu, whereas Acharya Harita has mentioned eight types of pandu including Kamala, Kumbhkamala, and Halimaka along with the above five types.

The symptoms of Pandu as mentioned in Ayurvedic texts show similarities with the disease Anemia and hence can be co-related.

v  There are number of definitions of Anaemia but the strict definition is an absolute decrease in RBC mass. To measure the RBC mass, the haematocrit or the haemoglobin in the blood is measured. Anaemia is typically diagnosed on complete blood count where RBC count, haemoglobin concentration, PCV, MCV, MCHC, are calculated and compared to the value adjusted for age and sex. Again, PBS study is done to see any abnormal RBC. Several schemes of classifications of anaemias have been proposed. Two of the widely accepted classifications are based on two criteria-

1 Pathophysiology of anaemia Anaemia due to blood loss, due to impaired red cell formation, due to increased red cell destruction

2 Morphological features in blood smear- Based on red cell size, haemoglobin content and red cell indices, anaemias are classified into three types-

a Microcytic, Hypochromic

b Normocytic, Normochromic

c Macrocytic, Normochromic

Most common form of anaemia, however, in the world, is due to nutritional deficiency of iron and Vitamin B12/folate, causing iron deficiency anaemia and megaloblastic anaemia respectively, together termed as nutritional anaemias.

NEED OF STUDY

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·     National family health survey NFHS-5 reveals prevalence of anaemia to be 67.1 percent in children, among which 59.1 percent is seen in females age group between 15 to 19 years. Anaemia is seen in 52.2 percent of the pregnant women and 25 percent in adult men age group 15-49 years

·        The prevalence of anaemia in India is high, majorly due to poor diet, worm infestation, irregular and altered food habits, consuming bakery products, fast foods etc. and these causes have similarities with the causes of Pandu Roga like intake of incompatible food/allergic food Asatmya Bhojanat, intake of antagonistic food Viruddha Bhojanat.

·       Thus, the nearest correlation of Pandu Roga can be made with Anaemia*,* on the basis of causes, signs and symptoms.

·       Anaemia is often labelled as the silent killer and is a significant public health challenge in India.

·       In the clinical practice probably physician diagnose the patient as Anaemia by doing their haematological investigations and then usually advises  Ayurvedic treatment of Pandu roga to the patient whereas different types of pandu roga have their specific line of treatment i.e. in Vataj pandu- snehapradhan aushadhi, in Pittaj pandu- tiktarasa and sheeta veerya dravya, in Kaphaj pandu -  katu, tikta, and ushna aushadhi, in Sannipataj pandu -vimishra aushadhi and in Mridbhakshan janya pandu- tikshna vaman virechana should be advised to the patient.

·       Spontaneous diagnosis of specific type of pandu roga in general medical practice is difficult due to lack of standard diagnostic techniques in classics. So, this study will be done to observe, evaluate and to establish whether there is any change in the morphology of RBCs and if there is, then what kind of change in RBCs are mostly seen in patients with Sannipataj Pandu so that we can apply the specific treatment as mentioned.

·       There has been very least amount of work done taking Sannipataj Pandu into account, also there is no clear demarcation of lakshanas available in Brihattrayi, and as most of the patients in clinical practice presents with mixed symptoms of doshaj pandu, it   becomes very important to rule out Sannipataj Pandu as correct diagnosis by spontaneous lab investigatory methods. Hence the above topic An observational study on Morphological changes of RBCs in Sannipataj Pandu Roga has been taken.