Changes

*The important pathological factors in ''pandu'' are aggravated three ''dosha'' with dominant ''pitta'' leading to slow metabolism at level of blood (''rakta''), the fatty tissue (''medas'') ''dhatu'' and ''ojas'' qualities (affecting the vitality).  

*The important pathological factors in ''pandu'' are aggravated three ''dosha'' with dominant ''pitta'' leading to slow metabolism at level of blood (''rakta''), the fatty tissue (''medas'') ''dhatu'' and ''ojas'' qualities (affecting the vitality).  

*The dietary factors like alkaline, sour, saline, hot and mutually contradictory foods, unwholesome food, ''nishpava'' (a type of pulses), māśa, piṇyāka (oil cake) and til oil; lifestyle factors like indulging in day sleep, performing exercise and sex before digestion of the food, disobedience of the seasonal regimens (ṛtu vaiśamya), suppression of the natural urges; iatrogenic factors like Improper administration of panchakarma measures (pratikarma vaiśamya) and the psychological factors like affliction of mind with passion, worry, fear, anger, grief are responsible for pandu.  

*The dietary factors like alkaline, sour, saline, hot and mutually contradictory foods, unwholesome food, ''nishpava'' (a type of pulses), ''masha, pinyaka'' (oil cake) and ''tila'' oil; lifestyle factors like indulging in day sleep, performing exercise and sex before digestion of the food, disobedience of the seasonal regimens (''ritu vaishamya''), suppression of the natural urges; iatrogenic factors like Improper administration of [[Panchakarma]] measures (''pratikarma vaishamya'') and the psychological factors like affliction of mind with passion, worry, fear, anger, grief are responsible for ''pandu''.  

• Heart and circulatory system are involved in the pathogenesis of pandu which is presented at the sites of skin and mānsa (flesh).

*Heart and circulatory system are involved in the pathogenesis of ''pandu'' which is presented at the sites of skin and ''mamsa'' (flesh).

• The specific features are observed as per the dosha dominance in pathogenesis.  

*The specific features are observed as per the ''dosha'' dominance in pathogenesis.  

• Person indulging in the habitual consumption of clay (mṛuttikā) gets dośhā aggravated according to the taste of mud viz. astringent mud aggravates vāta, saline and alkaline mud aggravates pitta and sweet mud aggravates kapha dośha. These factors cause pandu by affecting the dhatu and ojas.  

*Person indulging in the habitual consumption of clay (''mrittika'') gets ''dosha'' aggravated according to the taste of mud viz. astringent mud aggravates ''vata'', saline and alkaline mud aggravates ''pitta'' and sweet mud aggravates ''kapha dosha''. These factors cause ''pandu'' by affecting the ''dhatu'' and ''ojas''.  

• Chronic pāndu roga is incurable. The prognosis depends upon involvement of dhatu and its intensity.  

*Chronic ''pandu roga'' is incurable. The prognosis depends upon involvement of ''dhatu'' and its intensity.  

• If a patient of pāndu roga excessively consumes pitta vitiating diet and regimen, the aggravated pitta causes kāmalā by involving the rakta and the mānsa.  

*If a patient of ''pandu roga'' excessively consumes pitta vitiating diet and regimen, the aggravated ''pitta'' causes ''kamala'' by involving the ''rakta'' and the ''mamsa''.  

• First principle of management of pandu is administration of internal oleation (snehana) followed by strong (tikṡṇa) emetic and purgation therapies for cleansing of the body (shodhana). In patients of kāmalā, mild purgation therapy with bitter drugs is advised.

*First principle of management of ''pandu'' is administration of internal oleation (''snehana'') followed by strong (''teekshna'') emetic and purgation therapies for cleansing of the body (''shodhana''). In patients of ''kamala'', mild purgation therapy with bitter drugs is advised.

• Kamala is of two types: Koshtha-shaksha shrita and shakhashrita. In koshtha-shakhashrita kamala there is excess increase in pitta.  

*''Kamala'' is of two types: ''Koshtha-shaksha shrita'' and ''shakhashrita''. In ''koshtha-shakhashrita kamala'' there is excess increase in ''pitta''.  

• In shakhashrita kamala, pitta is obstructed by kapha and improperly circulated by vata. Therefore the treatment principles differ in both.  

*In ''shakhashrita kamala'', ''pitta'' is obstructed by ''kapha'' and improperly circulated by ''vata''. Therefore the treatment principles differ in both.  

• In Koshtha-shaksha shrita kamala, mild purgation is administered with bitter drugs with a focus on pacification of pitta.  

*In ''koshtha-shaksha shrita kamala'', mild purgation is administered with bitter drugs with a focus on pacification of ''pitta''.  

• In shakhashrita kamala, principles of management are pacification of kapha, and anulomana of vata to derive pitta to its own natural site. Therefore ruksha, amla, katu drugs are used in the treatment.  

*In ''shakhashrita kamala'', principles of management are pacification of ''kapha'', and ''anulomana'' of ''vata'' to derive ''pitta'' to its own natural site. Therefore ''ruksha, amla, katu'' drugs are used in the treatment.  

• Suitable changes (combinations and permutations) in the treatment should be prescribed depending upon the strength of the dośhā in the patient. The therapy should be dominated by unctuous drugs (oil, ghee etc) for vātika type of pāndu; by bitter and cooling drugs for paittika type and by pungent, bitter and hot drugs for kaphaaj type of pāndu.

*Suitable changes (combinations and permutations) in the treatment should be prescribed depending upon the strength of the ''dosha'' in the patient. The therapy should be dominated by unctuous drugs (oil, ghee etc) for ''vatika'' type of ''pandu''; by bitter and cooling drugs for ''paittika'' type and by pungent, bitter and hot drugs for ''kaphaja'' type of ''pandu''.

• Strong elimination therapy is advised to remove the swallowed mud from the body after considering the strength of the patient. After the body is cleansed, different types of medicated ghee should be prescribed to the patient for promotion of strength.  

*Strong elimination therapy is advised to remove the swallowed mud from the body after considering the strength of the patient. After the body is cleansed, different types of medicated ghee should be prescribed to the patient for promotion of strength.  

• Halīmaka and is caused by the aggravation of vāta and pitta dośha. Hence the treatment focus on pacification of vata and pitta dosha.

*''Haleemaka'' and is caused by the aggravation of ''vata'' and ''pitta dosha''. Hence the treatment focus on pacification of ''vata'' and ''pitta dosha''.

=== Vidhi Vimarsha ===

=== Vidhi Vimarsha ===