Pandu Chikitsa

Pandu Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 16
Preceding Chapter	Grahani Chikitsa
Succeeding Chapter	Hikka Shwasa Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 16, Chapter on Management of Anemia and Disorders of Blood Deficiency)

Abstract

Pāndu roga (resembeling with anemia) is characterized by pallor which is associated with different colours according to dosha involved. Besides pandu roga, this chapter also describes two types of kāmalā (jaundice) which are two other associated diseases, caused by predominance of pitta dośa which causes alteration in normal colors of the body. The chapter describes general etiology, pathogenesis, symptoms etc of pāndu roga (anemia) as well as each of its five types viz. vāta, pitta, kapha, sannipataja and mruttika-bhakshana (clay eating) pāndu. After describing general principle of treatment of pāndu and kāmala, detailed treatment of each of the conditions mentioned above along with pathya (recommended diet) and apathya (prohibited diet) are given. Keywords – Pāndu roga, kāmalā, koshthashākhāshrita kāmalā shākhāshrita kāmalā pānakī, kumbhakāmalā, halīmaka, anemia, jaundice

Introduction

After the description of grahaṇī doṣha, the chapter on pāndu roga is given, as the causative factors of pāndu roga are quite similar to that of grahaṇī doṣha. Probably it is because that the various gastrointestinal problems can also lead to development of pāndu roga. The chapter deals with general discoloration of the body such as pallor, yellowish, greenish and whitish discoloration which is seen in skin, eyes, lips, face, nails, urine feces etc. Kāmala (jaundice) and halīmaka (severe obstructive jaundice) have also been included in this chapter as they are also characterized by the discoloration and may relate to pāndu roga. Kamla is of two types, swatantra (primay) and partantra (secondary). The etiological factors of primay kamla are described later. Secondary kamla develops in chronic phase of pandu in which vitiated pitta is seated in rasa dhatu and in kamla, pitta goes deeper in rakta dhatu and continues to go deeper in mans and medha dhatu, then it is called halimaka and kumbha kamla respectively. Kamla is of two types in repect to location, shakhshrit kamla located in body tissues in the form of obstructed pitta and koshthashrit kamla, localized to gut and can be easily removed by purgation while shakhashritkamla needs to be brought to gut for removal.

Sanskrit Text, Transliteration and English Translation

अथातः पाण्डुरोगचिकित्सितं व्याख्यास्यामः||१|| इति ह स्माह भगवानात्रेयः||२|| athātaḥ pāṇḍurōgacikitsitaṁ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātrēyaḥ||2|| athAtaH pANDurogacikitsitaM vyAkhyAsyAmaH||1|| iti ha smAha bhagavAnAtreyaH||2||

Now, we shall explain the chapter on the treatment of ‘pāndu roga’ said Lord Ātreya (1-2).

Five types of pāndu

पाण्डुरोगाः स्मृताः पञ्च वातपित्तकफैस्त्रयः| चतुर्थः सन्निपातेन पञ्चमो भक्षणान्मृदः||३|| pāṇḍurōgāḥ smr̥tāḥ pañca VātaPittaKaphaistrayaḥ| caturthaḥ sannipātēna pañcamō bhakṣaṇānmr̥daḥ||3|| pANDurogAH smRutAH pa~jca vAtapittakaphaistrayaH| caturthaH sannipAtena pa~jcamo bhakShaNAnmRudaH||3|| Pāndu roga is classified into five types as vātika, paittika, kaphaja, tridośaja and mrittikā bhakśhaṅa janya pāndu (3).

Pathogenesis of pāndu

दोषाः पित्तप्रधानास्तु यस्य कुप्यन्ति धातुषु| शैथिल्यं तस्य धातूनां गौरवं चोपजायते||४||

ततो वर्णबलस्नेहा ये चान्येऽप्योजसो गुणाः| व्रजन्ति क्षयमत्यर्थं दोषदूष्यप्रदूषणात्||५||

सोऽल्परक्तोऽल्पमेदस्को निःसारः शिथिलेन्द्रियः| वैवर्ण्यं भजते, तस्य हेतुं शृणु सलक्षणम्||६||

dōṣāḥ Pittapradhānāstu yasya kupyanti Dhātuṣu| śaithilyaṁ tasya dhātūnāṁ gauravaṁ cōpajāyatē||4||

tatō varṇabalasnēhā yē cānyē'pyōjasō guṇāḥ| vrajanti kṣayamatyarthaṁ dōṣadūṣyapradūṣaṇāt||5||

sō'lparaktō'lpamēdaskō niḥsāraḥ śithilēndriyaḥ| vaivarṇyaṁ bhajatē, tasya hētuṁ śr̥ṇu salakṣaṇam||6||

doShAH pittapradhAnAstu yasya kupyanti dhAtuShu| shaithilyaM tasya dhAtUnAM gauravaM copajAyate||4||

tato varNabalasnehA ye cAnye~apyojaso guNAH| vrajanti kShayamatyarthaM doShadUShyapradUShaNAt||5||

so~alparakto~alpamedasko niHsAraH shithilendriyaH| vaivarNyaM bhajate, tasya hetuM shRuNu salakShaNam||6||

Aggravated pitta predominant dośā vitiates the dhātu. This vitiation of dhātus cause sluggishnesss (śithilata) and heaviness (gaurava) in the dhātu resulting in diminution of complexion (varṇa), strength (bala), unctuousness (sneha) and the qualities of ojas. Thus, the person develops diminished blood (rakta) and the fatty tissue (medas) and absence of the vitality of all the tissues (niḥsāra) decreases functional status of sense organs (sithilendriyaḥ) and discolouration of the body. Hetu (etiological factors and pathogenesis) and the sign and symptoms of the disease will be explained hereafter (4-6).

General etio-pathogenesis of pāndu

क्षाराम्ललवणात्युष्णविरुद्धासात्म्यभोजनात्| निष्पावमाषपिण्याकतिलतैलनिषेवणात्||७|| विदग्धेऽन्ने दिवास्वप्नाद्व्यायामान्मैथुनात्तथा| प्रतिकर्मर्तुवैषम्याद्वेगानां च विधारणात्||८|| कामचिन्ताभयक्रोधशोकोपहतचेतसः| समुदीर्णं यदा पित्तं हृदये समवस्थितम्||९|| वायुना बलिना क्षिप्तं सम्प्राप्य धमनीर्दश| प्रपन्नं केवलं देहं त्वङ्मांसान्तरमाश्रितम्||१०|| प्रदूष्य कफवातासृक्त्वङ्मांसानि करोति तत्| पाण्डुहारिद्रहरितान् वर्णान् बहुविधांस्त्वचि||११|| स पाण्डुरोग इत्युक्तः ...|१२| kṣārāmlalavaṇātyuṣṇaviruddhāsātmyabhōjanāt| niṣpāvamāṣapiṇyākatilatailaniṣēvaṇāt||7|| vidagdhē'nnē divāsvapnādvyāyāmānmaithunāttathā| pratikarmartuvaiṣamyādvēgānāṁ ca vidhāraṇāt||8|| kāmacintābhayakrōdhaśōkōpahatacētasaḥ| samudīrṇaṁ yadā Pittaṁ hr̥dayē samavasthitam||9|| vāyunā balinā kṣiptaṁ samprāpya dhamanīrdaśa| prapannaṁ kēvalaṁ dēhaṁ tvaṅmāṁsāntaramāśritam||10|| pradūṣya Kaphavātāsr̥ktvaṅmāṁsāni karōti tat| pāṇḍuhāridraharitān varṇān bahuvidhāṁstvaci||11|| sa pāṇḍurōga ityuktaḥ ...|12|

kShArAmlalavaNAtyuShNaviruddhAsAtmyabhojanAt| niShpAvamAShapiNyAkatilatailaniShevaNAt||7|| vidagdhe~anne divAsvapnAdvyAyAmAnmaithunAttathA| pratikarmartuvaiShamyAdvegAnAM ca vidhAraNAt||8|| kAmacintAbhayakrodhashokopahatacetasaH| samudIrNaM yadA pittaM hRudaye samavasthitam||9|| vAyunA balinA kShiptaM samprApya dhamanIrdasha| prapannaM kevalaM dehaM tva~gmAMsAntaramAshritam||10|| pradUShya kaphavAtAsRuktva~gmAMsAni karoti tat| pANDuhAridraharitAn varNAn bahuvidhAMstvaci||11|| sa pANDuroga ityuktaH ...|12| Followings are the etiological factors of pāndu: • The (excessive) intake of alkaline, sour, saline, hot and mutually contradictory foods, unwholesome food, niśpāva (a type of pulses), māśa, piṇyāka (oil cake) and til oil; • Indulging in day sleep, performing exercise and sex before digestion of the food; • Improper administration of panchakarma measures (pratikarma vaiśamya) and the disobedience of the seasonal regimens (ṛtu vaiśamya) • Suppression of the natural urges • Affliction of mind with passion, worry, fear, anger, grief Indulgence in the above factors aggravates pitta seated in the cardiac region and then this pitta is forcefully propelled by the vāta into the ten dhamanies (attached to the heart) and further into the whole body. There, it gets located in between the tvachā (skin) and the mānsa (flesh) and additionally vitiates the kapha, vāta, rakta, tvachā and mānsa resulting in the development of various discolorations in the body like pāndu (pale), hāridra (yellow), harita (green). This is called as pāndu roga (7-11½ ).

Premonitory symptoms

.. तस्य लिङ्गं भविष्यतः| हृदयस्पन्दनं रौक्ष्यं स्वेदाभावः श्रमस्तथा||१२|| ... tasya liṅgaṁ bhaviṣyataḥ| hr̥dayaspandanaṁ raukṣyaṁ svēdābhāvaḥ śramastathā||12|| ... tasya li~ggaM bhaviShyataH| hRudayaspandanaM raukShyaM svedAbhAvaH shramastathA||12|| The premonitory symptoms of the disease are palpitations, ununctuousness, absence of sweating and fatigue (12).

General symptoms of pāndu

सम्भूतेऽस्मिन् भवेत् सर्वः कर्णक्ष्वेडी हतानलः| दुर्बलः सदनोऽन्नद्विट् श्रमभ्रमनिपीडितः||१३|| गात्रशूलज्वरश्वासगौरवारुचिमान्नरः| मृदितैरिव गात्रैश्च पीडितोन्मथितैरिव||१४|| शूनाक्षिकूटो हरितः शीर्णलोमा हतप्रभः| कोपनः शिशिरद्वेषी निद्रालुः ष्ठीवनोऽल्पवाक्||१५|| पिण्डिकोद्वेष्टकट्यूरुपादरुक्सदनानि च| भवन्त्यारोहणायासैर्विशेषश्चास्य [१] वक्ष्यते||१६|| sambhūtē'smin bhavēt sarvaḥ karṇakṣvēḍī hatānalaḥ| durbalaḥ sadanō'nnadviṭ śramabhramanipīḍitaḥ||13|| gātraśūlajvaraśvāsagauravārucimānnaraḥ| mr̥ditairiva gātraiśca pīḍitōnmathitairiva||14|| śūnākṣikūṭō haritaḥ śīrṇalōmā hataprabhaḥ| kōpanaḥ śiśiradvēṣī nidrāluḥ ṣṭhīvanō'lpavāk||15|| piṇḍikōdvēṣṭakaṭyūrupādaruksadanāni ca| bhavantyārōhaṇāyāsairviśēṣaścāsya [1] vakṣyatē||16|| sambhUte~asmin bhavet sarvaH karNakShveDI hatAnalaH| durbalaH sadano~annadviT shramabhramanipIDitaH||13|| gAtrashUlajvarashvAsagauravArucimAnnaraH| mRuditairiva gAtraishca pIDitonmathitairiva||14|| shUnAkShikUTo haritaH shIrNalomA hataprabhaH| kopanaH shishiradveShI nidrAluH ShThIvano~alpavAk||15|| piNDikodveShTakaTyUrupAdaruksadanAni ca| bhavantyArohaNAyAsairvisheShashcAsya [1] vakShyate||16|| On developing pāndu roga the patients have the symptoms of tinnitus, low digestion, weakness, prostration, disliking for food, fatigue, giddiness, pain in the body, fever, dyspnoea, heaviness and anorexia. The patient feels as if the limbs are being kneeded, pressed or churned; develops peri-orbital swelling, greenish complexion and falling of body hair. The person loses his body lusture, becomes irritable, dislikes cold things, feels sleepy, spits in excess, avoids speaking, suffers from cramps in the calf region and experiences excessive fatigue as well as pain and weakness in the lumbar region, thighs and feet specifically by exertion while climbing (13-16). The signs and symptoms specific to each variety of pāndu will be described henceforth.

Vātika pāndu

आहारैरुपचारैश्च वातलैः कुपितोऽनिलः| जनयेत्कृष्णपाण्डुत्वं [१] तथा रूक्षारुणाङ्गताम्||१७|| अङ्गमर्दं रुजं तोदं कम्पं पार्श्वशिरोरुजम्| वर्चःशोषास्यवैरस्यशोफानाहबलक्षयान्||१८|| āhārairupacāraiśca Vātalaiḥ kupitō'nilaḥ| janayētkr̥ṣṇapāṇḍutvaṁ [1] tathā rūkṣāruṇāṅgatām||17|| aṅgamardaṁ rujaṁ tōdaṁ kampaṁ pārśvaśirōrujam| varcaḥśōṣāsyavairasyaśōphānāhabalakṣayān||18|| AhArairupacAraishca vAtalaiH kupito~anilaH| janayetkRuShNapANDutvaM [1] tathA rUkShAruNA~ggatAm||17|| a~ggamardaM rujaM todaM kampaM pArshvashirorujam| varcaHshoShAsyavairasyashophAnAhabalakShayAn||18|| Indulging in vāta increasing diet and regimens aggravates vāta leading to vatika pāndu roga. The skin of the patient becomes blackish dawn coloured and un-unctuous. Its other symptoms are malaise, ache, pricking pain, tremor, pain in both the sides of the chest, headache; dried faeces, distaste in the mouth; swelling, gaseous distention of the abdomen and weakness (17-18).

Paittika pāndu

पित्तलस्याचितं पित्तं यथोक्तैः स्वैः प्रकोपणैः| दूषयित्वा तु रक्तादीन् पाण्डुरोगाय कल्पते||१९|| स पीतो हरिताभो वा ज्वरदाहसमन्वितः| तृष्णामूर्च्छापिपासार्तः [१] पीतमूत्रशकृन्नरः||२०|| स्वेदनः शीतकामश्च न चान्नमभिनन्दति| कटुकास्यो न चास्योष्णमुपशेतेऽम्लमेव च||२१|| उद्गारोऽम्लो विदाहश्च विदग्धेऽन्नेऽस्य जायते| दौर्गन्ध्यं भिन्नवर्चस्त्वं दौर्बल्यं तम एव च||२२|| Pittalasyācitaṁ Pittaṁ yathōktaiḥ svaiḥ prakōpaṇaiḥ| dūṣayitvā tu raktādīn pāṇḍurōgāya kalpatē||19|| sa pītō haritābhō vā jvaradāhasamanvitaḥ| tr̥ṣṇāmūrcchāpipāsārtaḥ [1] pītamūtraśakr̥nnaraḥ||20|| svēdanaḥ śītakāmaśca na cānnamabhinandati| kaṭukāsyō na cāsyōṣṇamupaśētē'mlamēva ca||21|| udgārō'mlō vidāhaśca vidagdhē'nnē'sya jāyatē| daurgandhyaṁ bhinnavarcastvaṁ daurbalyaṁ tama ēva ca||22||

pittalasyAcitaM pittaM yathoktaiH svaiH prakopaNaiH| dUShayitvA tu raktAdIn pANDurogAya kalpate||19|| sa pIto haritAbho vA jvaradAhasamanvitaH| tRuShNAmUrcchApipAsArtaH [1] pItamUtrashakRunnaraH||20|| svedanaH shItakAmashca na cAnnamabhinandati| kaTukAsyo na cAsyoShNamupashete~amlameva ca||21|| udgAro~amlo vidAhashca vidagdhe~anne~asya jAyate| daurgandhyaM bhinnavarcastvaM daurbalyaM tama eva ca||22|| Pitta gets aggravated by indulging in pitta vitiating nidānās (diet and regimens) which by involving the blood etc. causes pittaja pāndu. Its symptoms are, change in complexion to yellowish/greenish, fever, burning sensation; morbid thirst and fainting; excessive perspiration and longing for cold things and environment. The person does not relish food, develops pungent taste, disfavors hot and sour things; gets sour eructations associated with burning sensation due to impaired digestion of food; emits foul smell from mouth; the urine and stool become yellow in colour, has loose motions and develops weakness and fainting (19-22).

Kaphaja pāndu

विवृद्धः श्लेष्मलैः श्लेष्मा पाण्डुरोगं स पूर्ववत्| करोति गौरवं तन्द्रा छर्दिं श्वेतावभासताम्||२३|| प्रसेकं लोमहर्षं च सादं मूर्च्छां भ्रमं क्लमम्| श्वासं कासं तथाऽऽलस्यमरुचिं वाक्स्वरग्रहम्||२४|| शुक्लमूत्राक्षिवर्चस्त्वं कटुरूक्षोष्णकामताम्| श्वयथुं मधुरास्यत्वमिति [१] पाण्ड्वामयः कफात्||२५|| vivr̥ddhaḥ ślēṣmalaiḥ ślēṣmā pāṇḍurōgaṁ sa pūrvavat| karōti gauravaṁ tandrā chardiṁ śvētāvabhāsatām||23|| prasēkaṁ lōmaharṣaṁ ca sādaṁ mūrcchāṁ bhramaṁ klamam| śvāsaṁ kāsaṁ tathālasyamaruciṁ vāksvaragraham||24|| śuklamūtrākṣivarcastvaṁ kaṭurūkṣōṣṇakāmatām| śvayathuṁ madhurāsyatvamiti [1] pāṇḍvāmayaḥ kaphāt||25||

vivRuddhaH shleShmalaiH shleShmA pANDurogaM sa pUrvavat| karoti gauravaM tandrA chardiM shvetAvabhAsatAm||23|| prasekaM lomaharShaM ca sAdaM mUrcchAM bhramaM klamam| shvAsaM kAsaM tathA~a~alasyamaruciM vAksvaragraham||24|| shuklamUtrAkShivarcastvaM kaTurUkShoShNakAmatAm| shvayathuM madhurAsyatvamiti [1] pANDvAmayaH kaphAt||25|| Aggravated kapha by indulging in kapha increasing diet and regimen gives rise to kaphaja pāndu roga through the pathogenesis described earlier. The sign and symptom of kaphaja pāndu are heaviness, drowsiness, vomiting, whitish complexion, salivation, horripilation, prostration, fainting, giddiness, mental fatigue, dyspnoea, cough, laziness, anorexia, obstruction in speech and voice, whitish coloration of the eyes, urine and faeces; longing for pungent, ununctuous and hot things; and develops oedema and sweet taste in the mouth (23-25).

Tridoshaja pāndu

सर्वान्नसेविनः सर्वे दुष्टा दोषास्त्रिदोषजम्| त्रिदोषलिङ्गं कुर्वन्ति पाण्डुरोगं सुदुःसहम्||२६|| sarvānnasēvinaḥ sarvē duṣṭā dōṣāstridōṣajam| tridōṣaliṅgaṁ kurvanti pāṇḍurōgaṁ suduḥsaham||26|| sarvAnnasevinaH sarve duShTA doShAstridoShajam| tridoShali~ggaM kurvanti pANDurogaM suduHsaham||26|| Indulging in the etiological factors of all the three types of pāndu leads to aggravation of the three dosha resulting in tridoshaja pāndu with the features of all the three types of pāndu roga. This type of pāndu causes much distress to the patient (26).

Mr̥ttikā bhakshana pāndu

मृत्तिकादनशीलस्य कुप्यत्यन्यतमो मलः| कषाया मारुतं, पित्तमूषरा, मधुरा कफम्||२७|| कोपयेन्मृद्रसादींश्च रौक्ष्याद्भुक्तं विरूक्षयेत् [१] | पूरयत्यविपक्वैव स्रोतांसि निरुणद्धि च||२८|| इन्द्रियाणां बलं हत्वा तेजो वीर्यौजसी तथा| पाण्डुरोगं करोत्याशु बलवर्णाग्निनाशनम्||२९|| शूनगण्डाक्षिकूटभ्रूः [२] शूनपान्नाभिमेहनः| क्रिमिकोष्ठोऽतिसार्येत मलं सासृक् कफान्वितम्||३०|| mr̥ttikādanaśīlasya kupyatyanyatamō malaḥ| kaṣāyā mārutaṁ, Pittamūṣarā, madhurā Kapham||27|| kōpayēnmr̥drasādīṁśca raukṣyādbhuktaṁ virūkṣayēt [1] | pūrayatyavipakvaiva srōtāṁsi niruṇaddhi ca||28|| indriyāṇāṁ balaṁ hatvā tējō vīryaujasī tathā| pāṇḍurōgaṁ karōtyāśu balavarṇāgnināśanam||29|| śūnagaṇḍākṣikūṭabhrūḥ [2] śūnapānnābhimēhanaḥ| krimikōṣṭhō'tisāryēta malaṁ sāsr̥k kaphānvitam||30|| mRuttikAdanashIlasya kupyatyanyatamo malaH| kaShAyA mArutaM, pittamUSharA, madhurA kapham||27|| kopayenmRudrasAdIMshca raukShyAdbhuktaM virUkShayet [1] | pUrayatyavipakvaiva srotAMsi niruNaddhi ca||28|| indriyANAM balaM hatvA tejo vIryaujasI tathA| pANDurogaM karotyAshu balavarNAgninAshanam||29|| shUnagaNDAkShikUTabhrUH [2] shUnapAnnAbhimehanaH| krimikoShTho~atisAryeta malaM sAsRuk kaphAnvitam||30|| Person indulging in the habitual consumption of clay (mṛttikā) 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. The clay further because of its ununctuousness causes dryness in the rasa (nutrients of the digested food). The clay due to its undigestable nature fills and blocks the channels of circulation leading to decrease in the sharpness of the senses, lusture, energy and ojas (vital essence of the tissues). This quickly manifesting pāndu results in the loss of strength, complexion and digestive power. Its clinical features are edema of the cheeks, peri orbital edema and edema on the eyebrows area, feet, umbilical region and the pudendum; infestation of worms in the kośtha (gastrointestinal tract) and loose motions, the stool associated with blood and mucus (27-30).

Prognosis of pāndu

पाण्डुरोगश्चिरोत्पन्नः खरीभूतो न सिध्यति| कालप्रकर्षाच्छूनो [१] ना यश्च पीतानि पश्यति||३१|| बद्धाल्पविट्कं सकफं हरितं योऽतिसार्यते| दीनः श्वेतातिदिग्धाङ्गश्छर्दिमूर्च्छातृषार्दितः||३२|| स नास्त्यसृक्क्षयाद्यश्च पाण्डुः श्वेतत्वमाप्नुयात्| इति पञ्चविधस्योक्तं पाण्डुरोगस्य लक्षणम्||३३|| pāṇḍurōgaścirōtpannaḥ kharībhūtō na sidhyati| kālaprakarṣācchūnō [1] nā yaśca pītāni paśyati||31|| baddhālpaviṭkaṁ saKaphaṁ haritaṁ yō'tisāryatē| dīnaḥ śvētātidigdhāṅgaśchardimūrcchātr̥ṣārditaḥ||32|| sa nāstyasr̥kkṣayādyaśca pāṇḍuḥ śvētatvamāpnuyāt| iti pañcavidhasyōktaṁ pāṇḍurōgasya lakṣaṇam||33|| pANDurogashcirotpannaH kharIbhUto na sidhyati| kAlaprakarShAcchUno [1] nA yashca pItAni pashyati||31|| baddhAlpaviTkaM sakaphaM haritaM yo~atisAryate| dInaH shvetAtidigdhA~ggashchardimUrcchAtRuShArditaH||32|| sa nAstyasRukkShayAdyashca pANDuH shvetatvamApnuyAt| iti pa~jcavidhasyoktaM pANDurogasya lakShaNam||33|| Chronic pāndu roga is incurable. Other symptoms indicating the incurability are appearance of excessive dryness and edema; patient visualizes everything as yellow; passes very hard stool or less amount of stool or passes loose stool associated with mucus and green in colour; feels exceedingly prostrated; body becomes excessively white as if be smeared with whiteness; has vomiting, fainting and excessive thirst and when the patient develops excessive whiteness in the body as a result of loss of blood. Thus, the signs and symptoms of all the five type of pāndu roga have been described (31-33).

Kōṣṭhaśākhāśraya kamala

पाण्डुरोगी तु योऽत्यर्थं पित्तलानि निषेवते| तस्य पित्तमसृग्मांसं दग्ध्वा रोगाय कल्पते||३४|| हारिद्रनेत्रः स भृशं हारिद्रत्वङ्नखाननः| रक्तपीतशकृन्मूत्रो भेकवर्णो हतेन्द्रियः||३५|| दाहाविपाकदौर्बल्यसदनारुचिकर्षितः| कामला बहुपित्तैषा कोष्ठशाखाश्रया मता||३६|| pāṇḍurōgī tu yō'tyarthaṁ Pittalāni niṣēvatē| tasya Pittamasr̥gmāṁsaṁ dagdhvā rōgāya kalpatē||34|| hāridranētraḥ sa bhr̥śaṁ hāridratvaṅnakhānanaḥ| Rakta pītaśakr̥nmūtrō bhēkavarṇō hatēndriyaḥ||35|| dāhāvipākadaurbalyasadanārucikarṣitaḥ| kāmalā bahuPittaiṣā kōṣṭhaśākhāśrayā matā||36|| pANDurogI tu yo~atyarthaM pittalAni niShevate| tasya pittamasRugmAMsaM dagdhvA rogAya kalpate||34|| hAridranetraH sa bhRushaM hAridratva~gnakhAnanaH| raktapItashakRunmUtro bhekavarNo hatendriyaH||35|| dAhAvipAkadaurbalyasadanArucikarShitaH| kAmalA bahupittaiShA koShThashAkhAshrayA matA||36||

If a patient of pāndu roga excessively follows pitta vitiating diet and regimen, the pitta so aggravated by involving the rakta and the mānsa causes kāmalā. Its clinical features are the eyes, skin, nails and face of the patient become exceedingly yellow; stool and urine become redish-yellow in colour; complexion develops a colour similar to that of a frog (found in rainy season); the senses get impaired; has burning sensation, indigestion, weakness, prostration and anorexia. This kāmalā is caused by excess of pitta is known as kośthāśākhāśṛta (34-36).

Kumbha kāmalā

कालान्तरात् खरीभूता कृच्छ्रा स्यात् कुम्भकामला| 36½ kālāntarāt kharībhūtā kr̥cchrā syāt kumbhakāmalā| 36½ kAlAntarAt kharIbhUtA kRucchrA syAt kumbhakAmalA| With the due course of time the disease (kāmalā) becomes deep seated (kharibhūta) resulting in excessive dryness of the body or afflicted tissue and thus becomes difficult to cure. This condition is called kumbha kāmalā (36½).

Bad prognostic symptoms of kāmalā

कृष्णपीतशकृन्मूत्रो [१] भृशं शूनश्च मानवः||३७|| सरक्ताक्षिमुखच्छर्दिविण्मूत्रो यश्च ताम्यति| दाहारुचितृषानाहतन्द्रामोहसमन्वितः||३८|| नष्टाग्निसञ्ज्ञः क्षिप्रं हि कामलावान् विपद्यते|38½| kr̥ṣṇapītaśakr̥nmūtrō [1] bhr̥śaṁ śūnaśca mānavaḥ||37|| saraktākṣimukhacchardiviṇmūtrō yaśca tāmyati| dāhārucitr̥ṣānāhatandrāmōhasamanvitaḥ||38|| naṣṭāgnisañjñaḥ kṣipraṁ hi kāmalāvān vipadyatē|38½| kRuShNapItashakRunmUtro [1] bhRushaM shUnashca mAnavaH||37|| saraktAkShimukhacchardiviNmUtro yashca tAmyati| dAhArucitRuShAnAhatandrAmohasamanvitaH||38|| naShTAgnisa~jj~jaH kShipraM hi kAmalAvAn vipadyate|38½| If the stool and urine of the patient (of kāmalā) become black and yellow; develops excessive edema; eyes and face becomes red coloured; vomit, stool and urine are mixed with blood; the patient feels like going in darkness; has burning sensation, anorexia, morbid thirst, constipation, drowsiness and fainting; and the person looses his agni and consciousness; such patient may succumb to death quickly (37-38½).

Principles of treatment

साध्यानामितरेषां तु प्रवक्ष्यामि चिकित्सितम्||३९|| तत्र पाण्ड्वामयी स्निग्धस्तीक्ष्णैरूर्ध्वानुलोमिकैः| संशोध्यो मृदुभिस्तिक्तैः कामली तु विरेचनैः||४०|| ताभ्यां संशुद्धकोष्ठाभ्यां पथ्यान्यन्नानि दापयेत्| शालीन् सयवगोधूमान् पुराणान् यूषसंहितान्||४१|| मुद्गाढकीमसूरैश्च जाङ्गलैश्च रसैर्हितैः| यथादोषं विशिष्टं च तयोर्भैषज्यमाचरेत्||४२|| पञ्चगव्यं महातिक्तं कल्याणकमथापि वा| स्नेहनार्थं घृतं दद्यात् कामलापाण्डुरोगिणे||४३|| sādhyānāmitarēṣāṁ tu pravakṣyāmi cikitsitam||39|| tatra pāṇḍvāmayī snigdhastīkṣṇairūrdhvānulōmikaiḥ| saṁśōdhyō mr̥dubhistiktaiḥ kāmalī tu virēcanaiḥ||40|| tābhyāṁ saṁśuddhakōṣṭhābhyāṁ pathyānyannāni dāpayēt| śālīn sayavagōdhūmān purāṇān yūṣasaṁhitān||41|| mudgāḍhakīmasūraiśca jāṅgalaiśca rasairhitaiḥ| yathādōṣaṁ viśiṣṭaṁ ca tayōrbhaiṣajyamācarēt||42|| pañcagavyaṁ mahātiktaṁ kalyāṇakamathāpi vā| snēhanārthaṁ ghr̥taṁ dadyāt kāmalāpāṇḍurōgiṇē||43|| sAdhyAnAmitareShAM tu pravakShyAmi cikitsitam||39|| tatra pANDvAmayI snigdhastIkShNairUrdhvAnulomikaiH| saMshodhyo mRudubhistiktaiH kAmalI tu virecanaiH||40|| tAbhyAM saMshuddhakoShThAbhyAM pathyAnyannAni dApayet| shAlIn sayavagodhUmAn purANAn yUShasaMhitAn||41|| mudgADhakImasUraishca jA~ggalaishca rasairhitaiH| yathAdoShaM vishiShTaM ca tayorbhaiShajyamAcaret||42|| pa~jcagavyaM mahAtiktaM kalyANakamathApi vA| snehanArthaM ghRutaM dadyAt kAmalApANDurogiNe||43|| Now, the treatment for the curable types of pāndu roga is being described here - The patient suffering from the pāndu should first be given strong (tikṡṇa) emetic and purgation therapies after the administration of internal oleation (snehana) for cleansing of the body (shodhana). On the other hand, patient of kāmalā should be given mild purgation therapy with bitter drugs. After the cleansing of the koṡtha by the above procedures the patient of both of these diseases should be given wholesome food consisting of old śāli rice, barley and wheat mixed with the yuṡa (vegetable soup) of mudga, adhakī and masūra, and the rasa (meat soup) of animals inhabiting the arid zone. On the basis of the aggravated dośhās specific medicines are to be administered to the patients of these two categories (which will be described later in the chapter). For the oleation of the patient of pāndu and kāmala panchagavya ghṛita, mahātikta ghṛita and kalyānaka ghṛita should be given (39-43).

Dadimadya ghritam

दाडिमात् कुडवो धान्यात् कुडवार्धं पलं पलम्| चित्रकाच्छृङ्गवेराच्च पिप्पल्यष्टमिका तथा||४४|| तैः कल्कैर्विंशतिपलं घृतस्य सलिलाढके| सिद्धं हृत्पाण्डुगुल्मार्शःप्लीहवातकफार्तिनुत्||४५|| दीपनं श्वासकासघ्नं मूढवाते च शस्यते| दुःखप्रसविनीनां च वन्ध्यानां चैव गर्भदम्||४६|| इति दाडिमाद्यं घृतम्| dāḍimāt kuḍavō dhānyāt kuḍavārdhaṁ palaṁ palam| citrakācchr̥ṅgavērācca pippalyaṣṭamikā tathā||44|| taiḥ kalkairviṁśatipalaṁ ghr̥tasya salilāḍhakē| siddhaṁ hr̥tpāṇḍugulmārśaḥplīhaVātakaphārtinut||45|| dīpanaṁ śvāsakāsaghnaṁ mūḍhavātē ca śasyatē| duḥkhaprasavinīnāṁ ca vandhyānāṁ caiva garbhadam||46|| iti dāḍimādyaṁ ghr̥tam| dADimAt kuDavo dhAnyAt kuDavArdhaM palaM palam| citrakAcchRu~ggaverAcca pippalyaShTamikA tathA||44|| taiH kalkairviMshatipalaM ghRutasya salilADhake| siddhaM hRutpANDugulmArshaHplIhavAtakaphArtinut||45|| dIpanaM shvAsakAsaghnaM mUDhavAte ca shasyate| duHkhaprasavinInAM ca vandhyAnAM caiva garbhadam||46|| iti dADimAdyaM ghRutam|

Take twenty pala of ghee, one adhaka of water and add to it the paste prepared of one kudava of dādima, half kudava of dhānya, one pala each of chitraka and sr̥ṅgavēra and one aṣṭamikā (two karsha) of pippali and prepare ghee as per method of sneha pāka. This medicated ghee stimulates the power of digestion. It cures heart disease, anemia, gulma, hemorrhoids, spleenomegaly and disorders of vāta and kapha. It is also useful for curing asthma, bronchitis, mudha-vāta (claudication of vāta) and duhkha-prasava (difficult labour). It also helps a sterile woman to get offspring. Thus, ends the description of dadimādyaghrita (44-46).

Katukadyam ghritam

कटुका रोहिणी मुस्तं हरिद्रे वत्सकात् पलम्| पटोलं चन्दनं मूर्वा त्रायमाणा दुरालभा||४७|| कृष्णा पर्पटको निम्बो भूनिम्बो देवदारु च| तैः कार्षिकैर्घृतप्रस्थः सिद्धः क्षीरचतुर्गुणः||४८|| रक्तपित्तं ज्वरं दाहं श्वयथुं स भगन्दरम्| अर्शांस्यसृग्दरं चैव हन्ति विस्फोटकांस्तथा||४९|| इति कटुकाद्यं घृतम्| kaṭukā rōhiṇī mustaṁ haridrē vatsakāt palam| paṭōlaṁ candanaṁ mūrvā trāyamāṇā durālabhā||47|| kr̥ṣṇā parpaṭakō nimbō bhūnimbō dēvadāru ca| taiḥ kārṣikairghr̥taprasthaḥ siddhaḥ kṣīracaturguṇaḥ||48|| Rakta Pittaṁ jvaraṁ dāhaṁ śvayathuṁ sa bhagandaram| arśāṁsyasr̥gdaraṁ caiva hanti visphōṭakāṁstathā||49|| iti Kaṭukādyam Ghritam| kaTukA rohiNI mustaM haridre vatsakAt palam| paTolaM candanaM mUrvA trAyamANA durAlabhA||47|| kRuShNA parpaTako nimbo bhUnimbo devadAru ca| taiH kArShikairghRutaprasthaH siddhaH kShIracaturguNaH||48|| raktapittaM jvaraM dAhaM shvayathuM sa bhagandaram| arshAMsyasRugdaraM caiva hanti visphoTakAMstathA||49|| iti kaTukAdyaM ghRutam| One pala each of katukārohiṇī, mustā, haridrā, dāruharidrā, vatsaka in paste form, one karṡa of each of paṭola, chandana, mūrvā, trāyamāṇā, durālabhā, krśṇā, parpaṭaka, nimba, bhūnimba, devadāru should be added to one prastha of ghṛita and four prasthās of milk. This medicated ghee cures rakta pitta, jwara, dāha, svayathu, bhagandara, arśa, asrigadara and visphotaka. Thus described kaṭukādya ghri̥tam (47-49).

Pathyāghr̥itam

पथ्याशतरसे पथ्यावृन्तार्धशतकल्कवान्| प्रस्थः सिद्धो घृतात् पेयः स पाण्ड्वामयगुल्मनुत्||५०|| इति पथ्याघृतम्| pathyāśatarasē pathyāvr̥ntārdhaśatakalkavān| prasthaḥ siddhō ghr̥tāt pēyaḥ sa pāṇḍvāmayagulmanut||50|| iti pathyāghr̥tam| pathyAshatarase pathyAvRuntArdhashatakalkavAn| prasthaH siddho ghRutAt peyaH sa pANDvAmayagulmanut||50|| iti pathyAghRutam| The decoction of one hundred fruits of harītaki and the paste of fifty stalks of harītaki fruits should be added to one prastha of ghee and cooked. This medicated ghee cures pāndu and gulma (50).

Dantī ghri̥tam

दन्त्याश्चतुष्पलरसे पिष्टैर्दन्तीशलाटुभिः| तद्वत्प्रस्थो घृतात्सिद्धः प्लीहपाण्ड्वर्तिशोफजित्||५१|| इति दन्तीघृतम्| dantyāścatuṣpalarasē piṣṭairdantīśalāṭubhiḥ| tadvatprasthō ghr̥tātsiddhaḥ plīhapāṇḍvartiśōphajit||51|| iti dantīghr̥tam| dantyAshcatuShpalarase piShTairdantIshalATubhiH| tadvatprastho ghRutAtsiddhaH plIhapANDvartishophajit||51|| iti dantIghRutam| One prastha of ghee should be cooked by adding (one prastha of) the decoction of four palās pf dantī and the paste of the green fruits of dantī. Intake of this medicated ghee cures plīha (splenic disorders), pāndu and oedema (51).

Drākshaghri̥tam

पुराणसर्पिषः प्रस्थो द्राक्षार्धप्रस्थसाधितः| कामलागुल्मपाण्ड्वर्तिज्वरमेहोदरापहः||५२|| इति द्राक्षाघृतम्| purāṇasarpiṣaḥ prasthō drākṣārdhaprasthasādhitaḥ| kāmalāgulmapāṇḍvartijvaramēhōdarāpahaḥ||52|| iti drākṣāghr̥tam| purANasarpiShaH prastho drAkShArdhaprasthasAdhitaH| kAmalAgulmapANDvartijvaramehodarApahaH||52|| iti drAkShAghRutam| One prastha of old ghee should be added to half a prastha of drākśa and cooked. This medicated ghee cures kāmalā, gulma, pāndu, jwara, meha (polyuria) and udara roga (generalized abdominal enlargement)-(52).

Haridrādi ghri̥tam

हरिद्रात्रिफलानिम्बबलामधुकसाधितम्| सक्षीरं माहिषं सर्पिः कामलाहरमुत्तमम्||५३|| इति हरिद्रादिघृतम्| haridrātriphalānimbabalāmadhukasādhitam| sakṣīraṁ māhiṣaṁ sarpiḥ kāmalāharamuttamam||53|| iti haridrādighr̥tam| haridrAtriphalAnimbabalAmadhukasAdhitam| sakShIraM mAhiShaM sarpiH kAmalAharamuttamam||53|| iti haridrAdighRutam| Ghr̥ita prepared with haridrā, triphalā, nimba, balā, madhūka and buffalo’s milk and ghee is an excellent cure for kāmalā (53). Darvyadi ghritam: गोमूत्रे द्विगुणे दार्व्याः कल्काक्षद्वयसाधितः| दार्व्याः पञ्चपलक्वाथे कल्के कालीयके परः||५४|| माहिषात् सर्पिषः प्रस्थः पूर्वः पूर्वे परे परः|५५| gōmūtrē dviguṇē dārvyāḥ kalkākṣadvayasādhitaḥ| dārvyāḥ pañcapalakvāthē kalkē kālīyakē paraḥ||54|| māhiṣāt sarpiṣaḥ prasthaḥ pūrvaḥ pūrvē parē paraḥ|55| gomUtre dviguNe dArvyAH kalkAkShadvayasAdhitaH| dArvyAH pa~jcapalakvAthe kalke kAlIyake paraH||54|| mAhiShAt sarpiShaH prasthaH pUrvaH pUrve pare paraH|55| One prastha of buffalo’s ghee prepared by adding two prasthas of cow’s urine and the paste of two akṡa of the paste of dārvī as per sneha kalpana cures pāndu roga. One prastha of buffalo’s ghee prepared by adding with the decoction of five palas of dārvī and the paste of kālīyaka as per sneha kalpana cures kāmalā (54-55). Preparations for pāndu roga: स्नेहैरेभिरुपक्रम्य स्निग्धं मत्वा विरेचयेत्||५५|| पयसा मूत्रयुक्तेन बहुशः केवलेन वा| दन्तीफलरसे कोष्णे काश्मर्याञ्जलिना शृतम्||५६|| द्राक्षाञ्जलिं मृदित्वा वा दद्यात् पाण्ड्वामयापहम्| द्विशर्करं त्रिवृच्चूर्णं पलार्धं पैत्तिकः पिबेत्||५७|| कफपाण्डुस्तु गोमूत्रक्लिन्नयुक्तां [१] हरीतकीम्| आरग्वधं [२] रसेनेक्षोर्विदार्यामलकस्य च||५८|| सत्र्यूषणं बिल्वपत्रं पिबेन्ना कामलापहम्| दन्त्यर्धपलकल्कं वा द्विगुडं शीतवारिणा||५९|| कामली त्रिवृतां वाऽपि त्रिफलाया रसैः पिबेत्| विशालात्रिफलामुस्तकुष्ठदारुकलिङ्गकान्||६०|| कार्षिकानर्धकर्षांशां कुर्यादतिविषां तथा| कर्षौ मधुरसाया द्वौ सर्वमेतत् [३] सुखाम्बुना||६१|| मृदितं तं रसं पूतं पीत्वा लिह्याच्च मध्वनु| कासं श्वासं ज्वरं दाहं पाण्डुरोगमरोचकम्||६२|| गुल्मानाहामवातांश्च रक्तपित्तं च नाशयेत्| त्रिफलाया गुडूच्या वा दार्व्या निम्बस्य वा रसम्||६३|| शीतं मधुयुतं प्रातः कामलार्तः पिबेन्नरः| क्षीरमूत्रं पिबेत् पक्षं गव्यं माहिषमेव वा||६४|| पाण्डुर्गोमूत्रयुक्तं वा सप्ताहं त्रिफलारसम्| तरुजान् ज्वलितान्मूत्रे निर्वाप्यामृद्य चाङ्कुरान्||६५|| मातुलुङ्गस्य तत् पूतं पाण्डुशोथहरं पिबेत्| स्वर्णक्षीरी त्रिवृच्छ्यामे भद्रदारु सनागरम्||६६|| गोमूत्राञ्जलिना पिष्टं मूत्रे वा क्वथितं पिबेत्| क्षीरमेभिः शृतं वाऽपि पिबेद्दोषानुलोमनम्||६७|| हरीतकीं प्रयोगेण गोमूत्रेणाथवा पिबेत्| जीर्णे क्षीरेण भुञ्जीत रसेन मधुरेण वा||६८|| सप्तरात्रं गवां मूत्रे भावितं वाऽप्ययोरजः| पाण्डुरोगप्रशान्त्यर्थं पयसा पाययेद्भिषक्||६९|| snēhairēbhirupakramya snigdhaṁ matvā virēcayēt||55|| payasā mūtrayuktēna bahuśaḥ kēvalēna vā| dantīphalarasē kōṣṇē kāśmaryāñjalinā śr̥tam||56|| drākṣāñjaliṁ mr̥ditvā vā dadyāt pāṇḍvāmayāpaham| dviśarkaraṁ trivr̥ccūrṇaṁ palārdhaṁ paittikaḥ pibēt||57|| Kaphapāṇḍustu gōmūtraklinnayuktāṁ [1] harītakīm| āragvadhaṁ [2] rasēnēkṣōrvidāryāmalakasya ca||58|| satryūṣaṇaṁ bilvapatraṁ pibēnnā kāmalāpaham| dantyardhapalakalkaṁ vā dviguḍaṁ śītavāriṇā||59|| kāmalī trivr̥tāṁ vā'pi triphalāyā rasaiḥ pibēt| viśālātriphalāmustakuṣṭhadārukaliṅgakān||60|| kārṣikānardhakarṣāṁśāṁ kuryādativiṣāṁ tathā| karṣau madhurasāyā dvau sarvamētat [3] sukhāmbunā||61|| mr̥ditaṁ taṁ rasaṁ pūtaṁ pītvā lihyācca madhvanu| kāsaṁ śvāsaṁ jvaraṁ dāhaṁ pāṇḍurōgamarōcakam||62|| gulmānāhāmavātāṁśca Rakta Pittaṁ ca nāśayēt| triphalāyā guḍūcyā vā dārvyā nimbasya vā rasam||63|| śītaṁ madhuyutaṁ prātaḥ kāmalārtaḥ pibēnnaraḥ| kṣīramūtraṁ pibēt pakṣaṁ gavyaṁ māhiṣamēva vā||64|| pāṇḍurgōmūtrayuktaṁ vā saptāhaṁ triphalārasam| tarujān jvalitānmūtrē nirvāpyāmr̥dya cāṅkurān||65|| mātuluṅgasya tat pūtaṁ pāṇḍuśōthaharaṁ pibēt| svarṇakṣīrī trivr̥cchyāmē bhadradāru sanāgaram||66|| gōmūtrāñjalinā piṣṭaṁ mūtrē vā kvathitaṁ pibēt| kṣīramēbhiḥ śr̥taṁ vā'pi pibēddōṣānulōmanam||67|| harītakīṁ prayōgēṇa gōmūtrēṇāthavā pibēt| jīrṇē kṣīrēṇa bhuñjīta rasēna madhurēṇa vā||68|| saptarātraṁ gavāṁ mūtrē bhāvitaṁ vā'pyayōrajaḥ| pāṇḍurōgapraśāntyarthaṁ payasā pāyayēdbhiṣak||69|| snehairebhirupakramya snigdhaM matvA virecayet||55|| payasA mUtrayuktena bahushaH kevalena vA| dantIphalarase koShNe kAshmaryA~jjalinA shRutam||56|| drAkShA~jjaliM mRuditvA vA dadyAt pANDvAmayApaham| dvisharkaraM trivRuccUrNaM palArdhaM paittikaH pibet||57|| kaphapANDustu gomUtraklinnayuktAM [1] harItakIm| AragvadhaM [2] rasenekShorvidAryAmalakasya ca||58|| satryUShaNaM bilvapatraM pibennA kAmalApaham| dantyardhapalakalkaM vA dviguDaM shItavAriNA||59|| kAmalI trivRutAM vA~api triphalAyA rasaiH pibet| vishAlAtriphalAmustakuShThadArukali~ggakAn||60|| kArShikAnardhakarShAMshAM kuryAdativiShAM tathA| karShau madhurasAyA dvau sarvametat [3] sukhAmbunA||61|| mRuditaM taM rasaM pUtaM pItvA lihyAcca madhvanu| kAsaM shvAsaM jvaraM dAhaM pANDurogamarocakam||62|| gulmAnAhAmavAtAMshca raktapittaM ca nAshayet| triphalAyA guDUcyA vA dArvyA nimbasya vA rasam||63|| shItaM madhuyutaM prAtaH kAmalArtaH pibennaraH| kShIramUtraM pibet pakShaM gavyaM mAhiShameva vA||64|| pANDurgomUtrayuktaM vA saptAhaM triphalArasam| tarujAn jvalitAnmUtre nirvApyAmRudya cA~gkurAn||65|| mAtulu~ggasya tat pUtaM pANDushothaharaM pibet| svarNakShIrI trivRucchyAme bhadradAru sanAgaram||66|| gomUtrA~jjalinA piShTaM mUtre vA kvathitaM pibet| kShIramebhiH shRutaM vA~api pibeddoShAnulomanam||67|| harItakIM prayogeNa gomUtreNAthavA pibet| jIrNe kShIreNa bhu~jjIta rasena madhureNa vA||68|| saptarAtraM gavAM mUtre bhAvitaM vA~apyayorajaH| pANDurogaprashAntyarthaM payasA pAyayedbhiShak||69|| After proper oleation of the patient with the internal administration of the above described medicated ghṛita, the patient should be given frequent medication with the following recipies: Milk with cow’s urine or milk alone or lukewarm infusion of danti sprinkled with the powder of one anjalī of kāśmarya or mixed with the paste of one anjalī (handful) of drākṡā; all these drugs cure pāndu roga in general. The patient suffering from paittika pāndu should take half pala of trivṛtta mixed with one pala of sugar; Kaphaja type of pāndu patient should take harītakī chūrna immersed in cow’s urine. Kāmalā patient should take aragvadha along with the juice of sugarcane, vidārī, amalakī to which sunthī, maricha, pippali and bilva leaves have been added; or may take the paste of half pala of dantī mixed with one pala of jaggery along with cold water; or may take trivṛt along with decoction of triphalā. Viśālādi phānṭa – One karśa each of viśāla, harītaki, bibhītaka, amalakī, mustā, kuśtha, devadāru and kālingaka; half karśa of ativiśā, two karśa of madhurasa (mūrvā) should be made to a paste by triturating with lukewarm water and strained. The patient should take honey after taking this infusion. This phānta cures cough, dyspnoea, fever, burning sensation, pāndu roga, anorexia, gulma (lumps in abdomen), anāha (gaseous distention of the abdomen), amavāta (joint disorders caused by ama), and rakta pitta (bleeding disorders). Other drugs which are useful for these ailments are as follows: • Kāmalā patients should take the decoction of triphalā, guḍucī, devadāru, or nimba after cooling and adding honey in the morning. • Pāndu patient may take the milk or urine of either cow or buffalo for one fortnight. • Pāndu patient may drink the decoction of triphalā along with cow’s urine for one week. • Patient suffering from pāndu and sopha (oedema) should drink the liquid obtained by straining the paste of tender branches of mātulunga set afire and then immersed in cow’s urine. • Suvarṇakśīrī, trivṛt, syāmā-trivṛt, bhadradāru and nāgara should be triturated by adding one anjali of cow’s urine or should be made to a decoction by adding cow’s urine. The above mentioned drugs may also be boiled with milk. The drinking of these drugs brings about the downward motion of the dośhās causing pāndu. • Then again, the patient suffering from pāndu roga should take a course of harītaki with cow’s urine (for seven days) and then should take food either with milk or sweetened meat soup and • Physicians should give lauha bhasma impregnated for seven nights with cow’s urine along with milk for the alleviation of pāndu roga (55-69). Navāyasa chūrnam: त्र्यूषणत्रिफलामुस्तविडङ्गचित्रकाः समाः| नवायोरजसो भागास्तच्चूर्णं क्षौद्रसर्पिषा||७०|| भक्षयेत् पाण्डुहृद्रोगकुष्ठार्शःकामलापहम्| नवायसमिदं चूर्णं कृष्णात्रेयेण भाषितम्||७१|| इति नवायसचूर्णम्| tryūṣaṇatriphalāmustaviḍaṅgacitrakāḥ samāḥ| navāyōrajasō bhāgāstaccūrṇaṁ kṣaudrasarpiṣā||70|| bhakṣayēt pāṇḍuhr̥drōgakuṣṭhārśaḥkāmalāpaham| navāyasamidaṁ cūrṇaṁ kr̥ṣṇātrēyēṇa bhāṣitam||71|| iti navāyasacūrṇam| tryUShaNatriphalAmustaviDa~ggacitrakAH samAH| navAyorajaso bhAgAstaccUrNaM kShaudrasarpiShA||70|| bhakShayet pANDuhRudrogakuShThArshaHkAmalApaham| navAyasamidaM cUrNaM kRuShNAtreyeNa bhAShitam||71|| iti navAyasacUrNam| Take sunthi, pippali, maricha, harītakī, bibhītaki, amalakī, mustā, Vvdanga and chitraka in one part each and nine parts of Lauha bhasma and mix together. Intake of this recipie along with honey and ghī cures anemia, heart diseases, kuśtha (group of skin diseases), arśa (hemorrhoids) and kāmalā. This medicine propounded by Kriṣṇaātreya is called navāyasa chūrṇa (70-71). Mandūravatakā : गुडनागरमण्डूरतिलांशान्मानतः समान्| पिप्पलीद्विगुणां कुर्याद्गुटिकां पाण्डुरोगिणे||७२|| त्र्यूषणं त्रिफला मुस्तं विडङ्गं चव्यचित्रकौ| दार्वीत्वङ्माक्षिको धातुर्ग्रन्थिकं देवदारु च||७३|| एतान् द्विपलिकान्भागांश्चूर्णं कुर्यात् पृथक् पृथक्| मण्डूरं द्विगुणं चूर्णाच्छुद्धमञ्जनसन्निभम्||७४|| गोमूत्रेऽष्टगुणे पक्त्वा तस्मिंस्तत् प्रक्षिपेत्ततः| उदुम्बरसमान्कृत्वा वटकांस्तान् यथाग्नि ना||७५|| उपयुञ्जीत तक्रेण सात्म्यं जीर्णे च भोजनम्| मण्डूरवटका ह्येते प्राणदाः पाण्डुरोगिणाम्||७६|| कुष्ठान्यजीर्णकं शोथमूरुस्तम्भं कफामयान्| अर्शांसि कामलां मेहं प्लीहानं शमयन्ति च||७७|| इति मण्डूरवटकाः| guḍanāgaramaṇḍūratilāṁśānmānataḥ samān| pippalīdviguṇāṁ kuryādguṭikāṁ pāṇḍurōgiṇē||72|| tryūṣaṇaṁ triphalā mustaṁ viḍaṅgaṁ cavyacitrakau| dārvītvaṅmākṣikō Dhāturgranthikaṁ dēvadāru ca||73|| ētān dvipalikānbhāgāṁścūrṇaṁ kuryāt pr̥thak pr̥thak| maṇḍūraṁ dviguṇaṁ cūrṇācchuddhamañjanasannibham||74|| gōmūtrē'ṣṭaguṇē paktvā tasmiṁstat prakṣipēttataḥ| udumbarasamānkr̥tvā vaṭakāṁstān yathāgni nā||75|| upayuñjīta takrēṇa sātmyaṁ jīrṇē ca bhōjanam| maṇḍūravaṭakā hyētē prāṇadāḥ pāṇḍurōgiṇām||76|| kuṣṭhānyajīrṇakaṁ śōthamūrustambhaṁ kaphāmayān| arśāṁsi kāmalāṁ mēhaṁ plīhānaṁ śamayanti ca||77|| iti maṇḍūravaṭakāḥ| guDanAgaramaNDUratilAMshAnmAnataH samAn| pippalIdviguNAM kuryAdguTikAM pANDurogiNe||72|| tryUShaNaM triphalA mustaM viDa~ggaM cavyacitrakau| dArvItva~gmAkShiko dhAturgranthikaM devadAru ca||73|| etAn dvipalikAnbhAgAMshcUrNaM kuryAt pRuthak pRuthak| maNDUraM dviguNaM cUrNAcchuddhama~jjanasannibham||74|| gomUtre~aShTaguNe paktvA tasmiMstat prakShipettataH| udumbarasamAnkRutvA vaTakAMstAn yathAgni nA||75|| upayu~jjIta takreNa sAtmyaM jIrNe ca bhojanam| maNDUravaTakA hyete prANadAH pANDurogiNAm||76|| kuShThAnyajIrNakaM shothamUrustambhaM kaphAmayAn| arshAMsi kAmalAM mehaM plIhAnaM shamayanti ca||77|| iti maNDUravaTakAH|

Mandūra vātaka – jaggery, sunthi, mandūra and tila in one part each along with two parts of pippalī should be triturated and made in the form of pills. This medicine is suitable for the treatment of the patients with pāndu roga. Sunthī, pippalī, maricha, harītakī, bibhītakī, amalakī, mustā, vianga, cavya, citraka, bark of dāruharidrā, mākṣika (copper pyrite), pipalīmula and devadāru in the quantity of two pala each should be made to powders separately. Mandūra bhasma which is dark in color like collyrium, should be cooked by adding eight times of cow’s urine and the powders of the above drugs should be mixed to this. Vaṭakas (large sized pills) of the size of udumbara should be made out of this combination. This should be taken by the patient in the appropriate doses according to his agni (power of digestion and metabolism) along with butter milk. The patient should take wholesome food after its digestion. These pills named as mandūra vātaka are the life givers for the patients of pāndu. It also cures kuśtha, ajīrṇa (indigestion), sotha (oedema), urustambha (stiffening of the thighs), disease caused by aggravation of the kapha, arśa (hemorrhoids), kāmalā (jaundice), meha (polyuria) and plīha (splenic diseases). Thus ends the description of two types of mandūra vātaka. (72-77) Tapayadi lauha: ताप्याद्रिजतुरूप्यायोमलाः पञ्चपलाः पृथक्| चित्रकत्रिफलाव्योषविडङ्गैः पलिकैः सह||७८|| शर्कराष्टपलोन्मिश्राश्चूर्णिता मधुनाऽऽप्लुताः| अभ्यस्यास्त्वक्षमात्रा हि जीर्णे हितमिताशिना||७९|| कुलत्थकाकमाच्यादिकपोतपरिहारिणा|८०| tāpyādrijaturūpyāyōmalāḥ pañcapalāḥ pr̥thak| citrakatriphalāvyōṣaviḍaṅgaiḥ palikaiḥ saha||78|| śarkarāṣṭapalōnmiśrāścūrṇitā madhunāplutāḥ| abhyasyāstvakṣamātrā hi jīrṇē hitamitāśinā||79|| kulatthakākamācyādikapōtaparihāriṇā|80| tApyAdrijaturUpyAyomalAH pa~jcapalAH pRuthak| citrakatriphalAvyoShaviDa~ggaiH palikaiH saha||78|| sharkarAShTapalonmishrAshcUrNitA madhunA~a~aplutAH| abhyasyAstvakShamAtrA hi jIrNe hitamitAshinA||79|| kulatthakAkamAcyAdikapotaparihAriNA|80|

Tāpyādi yoga – Tāpya, silājatu, silver, mandūra in the amount of five pala each should be added to one pala each of chitraka, harītakī, bibhītaka, amalaki, sunthi, pippali, maricha and vidanga; and eight pala of sugar. This recipie should be taken by the patient habitually (by a pāndu rogī) in the dose of one karśa along with adequate amount of honey. After the digestion of this drug the patient should take wholesome food in small quantity and should avoid using kulattha, kākamācī etc. and pigeon meat (78-80). Yōgarāja: त्रिफलायास्त्रयो भागास्त्रयस्त्रिकटुकस्य च||८०|| भागश्चित्रकमूलस्य विडङ्गानां तथैव च| पञ्चाश्मजतुनो भागास्तथा रूप्यमलस्य च||८१|| माक्षिकस्य च शुद्धस्य लौहस्य रजसस्तथा| अष्टौ भागाः सितायाश्च तत्सर्वं सूक्ष्मचूर्णितम्||८२|| माक्षिकेणाप्लुतं स्थाप्यमायसे भाजने शुभे| उदुम्बरसमां मात्रां ततः खादेद्यथाग्नि ना||८३|| दिने दिने प्रयुञ्जीत जीर्णे भोज्यं यथेप्सितम्| वर्जयित्वा कुलत्थानि काकमाचीं कपोतकम्||८४|| योगराज इति ख्यातो योगोऽयममृतोपमः| रसायनमिदं श्रेष्ठं सर्वरोगहरं शिवम्||८५|| पाण्डुरोगं विषं कासं यक्ष्माणं विषमज्वरम्| कुष्ठान्यजीर्णकं मेहं शोषं श्वासमरोचकम्||८६|| विशेषाद्धन्त्यपस्मारं कामलां गुदजानि च| इति योगराजः|

triphalāyāstrayō bhāgāstrayastrikaṭukasya ca||80|| 

bhāgaścitrakamūlasya viḍaṅgānāṁ tathaiva ca| pañcāśmajatunō bhāgāstathā rūpyamalasya ca||81|| mākṣikasya ca śuddhasya lauhasya rajasastathā| aṣṭau bhāgāḥ sitāyāśca tatsarvaṁ sūkṣmacūrṇitam||82|| mākṣikēṇāplutaṁ sthāpyamāyasē bhājanē śubhē| udumbarasamāṁ mātrāṁ tataḥ khādēdyathāgni nā||83|| dinē dinē prayuñjīta jīrṇē bhōjyaṁ yathēpsitam| varjayitvā kulatthāni kākamācīṁ kapōtakam||84|| yōgarāja iti khyātō yōgō'yamamr̥tōpamaḥ| rasāyanamidaṁ śrēṣṭhaṁ sarvarōgaharaṁ śivam||85|| pāṇḍurōgaṁ viṣaṁ kāsaṁ yakṣmāṇaṁ viṣamajvaram| kuṣṭhānyajīrṇakaṁ mēhaṁ śōṣaṁ śvāsamarōcakam||86|| viśēṣāddhantyapasmāraṁ kāmalāṁ gudajāni ca| iti yōgarājaḥ| triphalAyAstrayo bhAgAstrayastrikaTukasya ca||80|| bhAgashcitrakamUlasya viDa~ggAnAM tathaiva ca| pa~jcAshmajatuno bhAgAstathA rUpyamalasya ca||81|| mAkShikasya ca shuddhasya lauhasya rajasastathA| aShTau bhAgAH sitAyAshca tatsarvaM sUkShmacUrNitam||82|| mAkShikeNAplutaM sthApyamAyase bhAjane shubhe| udumbarasamAM mAtrAM tataH khAdedyathAgni nA||83|| dine dine prayu~jjIta jIrNe bhojyaM yathepsitam| varjayitvA kulatthAni kAkamAcIM kapotakam||84|| yogarAja iti khyAto yogo~ayamamRutopamaH| rasAyanamidaM shreShThaM sarvarogaharaM shivam||85|| pANDurogaM viShaM kAsaM yakShmANaM viShamajvaram| kuShThAnyajIrNakaM mehaM shoShaM shvAsamarocakam||86|| visheShAddhantyapasmAraM kAmalAM gudajAni ca| iti yogarAjaH| Yogarāja – harītakī, bibhītakī, amalakī, shunthī, pippalī, maricha, chitraka mūla (root) and vidanga in the amount of one part each; five parts each of silājatu, raupya mala (silver), purified mākṡika and lauha bhasma; eight parts of sugar – all should be made to a fine powder and mixed with adequate amount of honey and kept in clean iron jar. This recipie should be taken by the patient in a quantity equal to a fruit of udambara according to the power of digestion every day and should be given the desired food excluding kulattha, kākamācī etc. and pigeon meat; only after the digestion of the taken drug. This ambrosia like recipe is called yogarāja. It is an excellent rejuvenative recipe which cures all diseases and bestows auspiciousness. It specially cures pāndu, poisoning, kāsa, yakṡmā, viśama jwara (irregular fevers), ajīrṇa, meha, soṡha, swāsa, aruci, apasmāra (epilepsy), kāmalā and arśa. Thus ends the description of yogarāja (80-86). Preparations for pāndu: कौटजत्रिफलानिम्बपटोलघननागरैः||८७|| भावितानि दशाहानि रसैर्द्वित्रिगुणानि वा| शिलाजतुपलान्यष्टौ तावती सितशर्करा||८८|| त्वक्क्षीरी पिप्पली धात्री कर्कटाख्या पलोन्मिता| निदिग्ध्याः फलमूलाभ्यां पलं युक्त्या त्रिगन्धकम्| चूर्णितं मधुनः कुर्यात् त्रिपलेनाक्षिकान् गुडान्| दाडिमाम्बुपयःपक्षिरसतोयसुरासवान्||९०|| तान् भक्षयित्वाऽनुपिबेन्निरन्नो भुक्त एव वा| पाण्डुकुष्ठज्वरप्लीहतमकार्शोभगन्दरान्||९१|| पूतिहृच्छुक्रमूत्राग्निदोषशोषगरोदरान् [१] | कासासृग्दरपित्तासृक्शोथगुल्मगलामयान्||९२|| ते च सर्वव्रणान् हन्युः सर्वरोगहराः शिवाः| इति शिलाजतुवटकाः| पुनर्नवा त्रिवृद्व्योषविडङ्गं दारु चित्रकम्||९३|| कुष्ठं हरिद्रे त्रिफला दन्ती चव्यं कलिङ्गकाः| पिप्पली [२] पिप्पलीमूलं मुस्तं चेति पलोन्मितम्||९४|| मण्डूरं द्विगुणं चूर्णाद्गोमूत्रे द्व्याढके पचेत्| कोलवद्गुटिकाः कृत्वा तक्रेणालोड्य ना पिबेत्||९५|| ताः पाण्डुरोगान् प्लीहानमर्शांसि विषमज्वरम्| श्वयथुं ग्रहणीदोषं हन्युः कुष्ठं क्रिमींस्तथा||९६|| इति पुनर्नवामण्डूरम्| दार्वीत्वक् त्रिफला व्योषं विडङ्गमयसो रजः| मधुसर्पिर्युतं लिह्यात् कामलापाण्डुरोगवान्||९७|| तुल्या अयोरजःपथ्याहरिद्राः क्षौद्रसर्पिषा| चूर्णिताः कामली लिह्याद्गुडक्षौद्रेण वाऽभयाः||९८|| त्रिफला द्वे हरिद्रे च कटुरोहिण्ययोरजः| चूर्णितं क्षौद्रसर्पिर्भ्यां स लेहः कामलापहः||९९|| kauṭajatriphalānimbapaṭōlaghananāgaraiḥ||87|| bhāvitāni daśāhāni rasairdvitriguṇāni vā| śilājatupalānyaṣṭau tāvatī sitaśarkarā||88|| tvakkṣīrī pippalī dhātrī karkaṭākhyā palōnmitā| nidigdhyāḥ phalamūlābhyāṁ palaṁ yuktyā trigandhakam| cūrṇitaṁ madhunaḥ kuryāt tripalēnākṣikān guḍān| dāḍimāmbupayaḥpakṣirasatōyasurāsavān||90|| tān bhakṣayitvā'nupibēnnirannō bhukta ēva vā| pāṇḍukuṣṭhajvaraplīhatamakārśōbhagandarān||91|| pūtihr̥cchukramūtrāgnidōṣaśōṣagarōdarān [1] | kāsāsr̥gdarapittāsr̥kśōthagulmagalāmayān||92|| tē ca sarvavraṇān hanyuḥ sarvarōgaharāḥ śivāḥ| iti śilājatuvaṭakāḥ| punarnavā trivr̥dvyōṣaviḍaṅgaṁ dāru citrakam||93|| kuṣṭhaṁ haridrē triphalā dantī cavyaṁ kaliṅgakāḥ| pippalī [2] pippalīmūlaṁ mustaṁ cēti palōnmitam||94|| maṇḍūraṁ dviguṇaṁ cūrṇādgōmūtrē dvyāḍhakē pacēt| kōlavadguṭikāḥ kr̥tvā takrēṇālōḍya nā pibēt||95|| tāḥ pāṇḍurōgān plīhānamarśāṁsi viṣamajvaram| śvayathuṁ grahaṇīdōṣaṁ hanyuḥ kuṣṭhaṁ krimīṁstathā||96|| iti punarnavāmaṇḍūram| dārvītvak triphalā vyōṣaṁ viḍaṅgamayasō rajaḥ| madhusarpiryutaṁ lihyāt kāmalāpāṇḍurōgavān||97|| tulyā ayōrajaḥpathyāharidrāḥ kṣaudrasarpiṣā| cūrṇitāḥ kāmalī lihyādguḍakṣaudrēṇa vā'bhayāḥ||98|| triphalā dvē haridrē ca kaṭurōhiṇyayōrajaḥ| cūrṇitaṁ kṣaudrasarpirbhyāṁ sa lēhaḥ kāmalāpahaḥ||99||

kauTajatriphalAnimbapaTolaghananAgaraiH||87|| bhAvitAni dashAhAni rasairdvitriguNAni vA| shilAjatupalAnyaShTau tAvatI sitasharkarA||88|| tvakkShIrI pippalI dhAtrI karkaTAkhyA palonmitA| nidigdhyAH phalamUlAbhyAM palaM yuktyA trigandhakam| cUrNitaM madhunaH kuryAt tripalenAkShikAn guDAn| dADimAmbupayaHpakShirasatoyasurAsavAn||90|| tAn bhakShayitvA~anupibenniranno bhukta eva vA| pANDukuShThajvaraplIhatamakArshobhagandarAn||91|| pUtihRucchukramUtrAgnidoShashoShagarodarAn [1] | kAsAsRugdarapittAsRukshothagulmagalAmayAn||92|| te ca sarvavraNAn hanyuH sarvarogaharAH shivAH| iti shilAjatuvaTakAH| punarnavA trivRudvyoShaviDa~ggaM dAru citrakam||93|| kuShThaM haridre triphalA dantI cavyaM kali~ggakAH| pippalI [2] pippalImUlaM mustaM ceti palonmitam||94|| maNDUraM dviguNaM cUrNAdgomUtre dvyADhake pacet| kolavadguTikAH kRutvA takreNAloDya nA pibet||95|| tAH pANDurogAn plIhAnamarshAMsi viShamajvaram| shvayathuM grahaNIdoShaM hanyuH kuShThaM krimIMstathA||96|| iti punarnavAmaNDUram| dArvItvak triphalA vyoShaM viDa~ggamayaso rajaH| madhusarpiryutaM lihyAt kAmalApANDurogavAn||97|| tulyA ayorajaHpathyAharidrAH kShaudrasarpiShA| cUrNitAH kAmalI lihyAdguDakShaudreNa vA~abhayAH||98|| triphalA dve haridre ca kaTurohiNyayorajaH| cUrNitaM kShaudrasarpirbhyAM sa lehaH kAmalApahaH||99|| Shilājatu vataka – Eight pala of silājatu impregnated for ten, twenty or thirty days with the decoction of fruit of kutaja, harītakī, bibhītaka, amalakī, nimba, patola, ghana and nāgara. Eight pala of sugar and one pala each of tvakakṡīrī, pippalī, dhātrī and karkaṭaśṛngī; half pala each of the fruit and root of nidigdhikā and adequate powder of tvaka, elā and patra should be added to this silājatu. Vaṭaka (large sized pills) of one akṡa each should be prepared by adding three pala of honey to this powder. These pills can be taken on either empty stomach or after having food. The patient should drink the juice of dāḍima (pomegranate), milk, meat soup of birds, water, alcohol, asava (medicated wine) after taking this medicine. It cures pāndu, kuṡtha, jwara, plīhā, tamaka svāsa, arśa, bhagandara (fistula in ano), pūti (putrified ulcers), hṛdroga (heart diseases), shukra dośha (diseases of semen), mūtra dośha (diseases of urine), and agni dosha (diseases of digestion), soṡa (consumption), gara (poisoning), udara, kāsa, asṛgdara (menorrhagia), rakta pitta (bleeding disorders), sotha, gulma, galāmayāna (diseases of the throats) and all types of vraṇa (wounds). It cures all types of diseases and bestows auspiciousness. Thus, ends the description of shilājatu vātaka. Punarnavā Manḍūra – Powder of one pala each of punarnavā, trivṛta, sunthī, pippalī, maricha, vidanga, devadāru, chitraka, kuśtha, haridrā, dāruharidrā, harītakī, bibhītaka, amalakī, dantī, cavya, kālingaka, pippalī, pippalī mūla and mustā; and forty palā of mandūra bhasma (rust of iron) coked in two adhaka of cow’s urine and made in the form of gutikā of the size of kola. These pills should be taken with butter milk. It cures pāndu, plīhā, arsa, viṡama jwara, sotha, grahanīdosha (sprue syndrome, irritable bowel syndrome), kuśtha and krimī (parasitic infestation). Thus, ends the description of punarnavā mandūra. Dārvyādi leha: Powder of the bark of dāruharidrā, harītakī, bibhītaka, amalakī, pippalī, sunthi, maricha, vydanga and lauha bhasma mixed with ghee and honey, taken as a linctus by the patients suffering from pāndu and kāmalā. Two other recipes – Patients suffering from kāmalā should take the powder of one part each of lauha bhasma, harītakī and haridrā along with honey and ghee and may also take the linctus of the powder of abhayā prepared by mixing with jagery and honey (87-99). Dhātryāvaleha: द्विपलांशां तुगाक्षीरीं नागरं मधुयष्टिकाम्| प्रास्थिकीं पिप्पलीं द्राक्षां शर्करार्धतुलां शुभाम्||१००|| धात्रीफलरसद्रोणे चूर्णितं लेहवत् पचेत्| शीतं मधुप्रस्थयुतं लिह्यात् पाणितलं ततः||१०१|| हन्त्येष कामलां पित्तं पाण्डुं कासं हलीमकम्| इति धात्र्यवलेहः| dvipalāṁśāṁ tugākṣīrīṁ nāgaraṁ madhuyaṣṭikām| prāsthikīṁ pippalīṁ drākṣāṁ śarkarārDhātulāṁ śubhām||100|| dhātrīphalarasadrōṇē cūrṇitaṁ lēhavat pacēt| śītaṁ madhuprasthayutaṁ lihyāt pāṇitalaṁ tataḥ||101|| hantyēṣa kāmalāṁ Pittaṁ pāṇḍuṁ kāsaṁ halīmakam| iti dhātryavalēhaḥ| dvipalAMshAM tugAkShIrIM nAgaraM madhuyaShTikAm| prAsthikIM pippalIM drAkShAM sharkarArdhatulAM shubhAm||100|| dhAtrIphalarasadroNe cUrNitaM lehavat pacet| shItaM madhuprasthayutaM lihyAt pANitalaM tataH||101|| hantyeSha kAmalAM pittaM pANDuM kAsaM halImakam| iti dhAtryavalehaH| Dhātryāvaleha – Vanśalocana, sunthī, maduyaśṭī powders, each in two pala; one prastha each of pippalī and drākṡā; and half a tulā of sugar crystal added with one droṇa of amalakī fruit juice and cooked till it changes into linctus form. One prastha of honey is added to it after it cools down. Intake of one pāṇitala of this linctus cures kāmalā, pitta vikārās, pāndu, kāsa and halīmaka (100-101). Mandūravatakāh: त्र्यूषणं त्रिफला चव्यं चित्रको देवदारु च||१०२|| विडङ्गान्यथ मुस्तं च वत्सकं चेति चूर्णयेत्| मण्डूरतुल्यं तच्चूर्णं गोमूत्रेऽष्टगुणे पचेत्||१०३|| शनैः सिद्धास्तथा शीताः कार्याः कर्षसमा गुडाः| यथाग्नि भक्षणीयास्ते प्लीहपाण्ड्वामयापहाः||१०४|| ग्रहण्यर्शोनुदश्चैव तक्रवाट्याशिनः स्मृताः| इति मण्डूरवटकाः| tryūṣaṇaṁ triphalā cavyaṁ citrakō dēvadāru ca||102|| viḍaṅgānyatha mustaṁ ca vatsakaṁ cēti cūrṇayēt| maṇḍūratulyaṁ taccūrṇaṁ gōmūtrē'ṣṭaguṇē pacēt||103|| śanaiḥ siddhāstathā śītāḥ kāryāḥ karṣasamā guḍāḥ| yathāgni bhakṣaṇīyāstē plīhapāṇḍvāmayāpahāḥ||104|| grahaṇyarśōnudaścaiva takravāṭyāśinaḥ smr̥tāḥ| iti maṇḍūravaṭakāḥ| tryUShaNaM triphalA cavyaM citrako devadAru ca||102|| viDa~ggAnyatha mustaM ca vatsakaM ceti cUrNayet| maNDUratulyaM taccUrNaM gomUtre~aShTaguNe pacet||103|| shanaiH siddhAstathA shItAH kAryAH karShasamA guDAH| yathAgni bhakShaNIyAste plIhapANDvAmayApahAH||104|| grahaNyarshonudashcaiva takravATyAshinaH smRutAH| iti maNDUravaTakAH| Manḍūra Vataka-II: Śunṭhī, pippalī, maricha, harītakī, bibhītaka, amalakī, cavyya, chitraka, devadārū, viḍanga, mustā and vatsaka in one part each, made in the form of powder and added to equal quantity (12 parts) of manḍūra bhasma, should then be boiled by adding eight times of cow’s urine over mild fire. After the recipe cools pills of one akśa each should be prepared and taken according to the power of digestion. This cures plīhā, pāndu, grahaṇī, and arśa. The patient should take butter milk and vāṭya (a roasted barley preperation) while taking this pill (102-104). Gauḍō ariṣṭaḥ: मञ्जिष्ठा रजनी द्राक्षा बलामूलान्ययोरजः||१०५|| लोध्रं चैतेषु गौडः स्यादरिष्टः पाण्डुरोगिणाम्| इति गौडोऽरिष्टः| mañjiṣṭhā rajanī drākṣā balāmūlānyayōrajaḥ||105|| lōdhraṁ caitēṣu gauḍaḥ syādariṣṭaḥ pāṇḍurōgiṇām| iti gauḍō'riṣṭaḥ| ma~jjiShThA rajanI drAkShA balAmUlAnyayorajaH||105|| lodhraM caiteShu gauDaH syAdariShTaH pANDurogiNAm| iti gauDo~ariShTaH|

Manjiśṭhā, rajanī, drakṡā, balā mūla (roots), lauha bhasma, and lodhra should be added to jaggery and processed according to the method prescribed for ariṡṭa. It is called gauḍo-ariṡṭa and is useful for the patients suffering from pāndu roga (105). Bījakāriṣṭa: बीजकात्षोडशपलं त्रिफलायाश्च विंशतिः||१०६|| द्राक्षायाः पञ्च लाक्षायाः सप्त द्रोणे जलस्य तत्| साध्यं पादावशेषे तु पूतशेषे समावपेत्||१०७|| शर्करायास्तुलां प्रस्थं माक्षिकस्य च कार्षिकम्| व्योषं व्याघ्रनखोशीरं क्रमुकं सैलवालुकम्||१०८|| मधुकं कुष्ठमित्येतच्चूर्णितं घृतभाजने| यवेषु दशरात्रं तद्ग्रीष्मे द्विः शिशिरे स्थितम्||१०९|| पिबेत्तद्ग्रहणीपाण्डुरोगार्शःशोथगुल्मनुत्| मूत्रकृच्छ्राश्मरीमेहकामलासन्निपातजित्||११०|| बीजकारिष्ट इत्येष आत्रेयेण प्रकीर्तितः| इति बीजकारिष्टः| bījakātṣōḍaśapalaṁ triphalāyāśca viṁśatiḥ||106|| drākṣāyāḥ pañca lākṣāyāḥ sapta drōṇē jalasya tat| sādhyaṁ pādāvaśēṣē tu pūtaśēṣē samāvapēt||107|| śarkarāyāstulāṁ prasthaṁ mākṣikasya ca kārṣikam| vyōṣaṁ vyāghranakhōśīraṁ kramukaṁ sailavālukam||108|| madhukaṁ kuṣṭhamityētaccūrṇitaṁ ghr̥tabhājanē| yavēṣu daśarātraṁ tadgrīṣmē dviḥ śiśirē sthitam||109|| pibēttadgrahaṇīpāṇḍurōgārśaḥśōthagulmanut| mūtrakr̥cchrāśmarīmēhakāmalāsannipātajit||110|| bījakāriṣṭa ityēṣa ātrēyēṇa prakīrtitaḥ| iti bījakāriṣṭaḥ| bIjakAtShoDashapalaM triphalAyAshca viMshatiH||106|| drAkShAyAH pa~jca lAkShAyAH sapta droNe jalasya tat| sAdhyaM pAdAvasheShe tu pUtasheShe samAvapet||107|| sharkarAyAstulAM prasthaM mAkShikasya ca kArShikam| vyoShaM vyAghranakhoshIraM kramukaM sailavAlukam||108|| madhukaM kuShThamityetaccUrNitaM ghRutabhAjane| yaveShu dasharAtraM tadgrIShme dviH shishire sthitam||109|| pibettadgrahaNIpANDurogArshaHshothagulmanut| mUtrakRucchrAshmarImehakAmalAsannipAtajit||110|| bIjakAriShTa ityeSha AtreyeNa prakIrtitaH| iti bIjakAriShTaH| Bījaka taken in the amount of sixteen pala, twenty pala of triphalā, five pala of drākṡā and seven pala of lākṡā are added to one droṇa of water and boiled till one fourth of water remains. Water should then be taken out by straining. One Tulā of sugar, one pala of honey and one pala powder of each of the sunṭhī, pippalī, maricha, vyāghranakha, kramuka, elavāluka, madhūka and kuṡṭha are added to the above made decoction and the potion be stored in a jar smeared with ghee kept inside a barley heap for ten nights during summer and for twenty nights in winter. Intake of this potion cures grahaṇī, pāndu, arśa, sotha, gulma, mūtra kṛchha (dysuria), aśmarī (stones in the urinary tract), meha, kāmalā and diseases caused by all the three dośhās. This is called bijaka ariśṭa and it was propounded by Ātreya. Thus, ends the description of bijaka ariśṭa (106-110). Dhātryariṣṭa: धात्रीफलसहस्रे द्वे पीडयित्वा रसं तु तम्||१११|| क्षौद्राष्टांशेन संयुक्तं कृष्णार्धकुडवेन च| शर्करार्धतुलोन्मिश्रं पक्षं स्निग्धघटे स्थितम्||११२|| प्रपिबेन्मात्रया प्रातर्जीर्णे हितमिताशनः| कामलापाण्डुहृद्रोगवातासृग्विषमज्वरान्||११३|| कासहिक्कारुचिश्वासांश्चैषोऽरिष्टः प्रणाशयेत्| इति धात्र्यरिष्टः dhātrīphalasahasrē dvē pīḍayitvā rasaṁ tu tam||111|| kṣaudrāṣṭāṁśēna saṁyuktaṁ kr̥ṣṇārdhakuḍavēna ca| śarkarārDhātulōnmiśraṁ pakṣaṁ snigdhaghaṭē sthitam||112|| prapibēnmātrayā prātarjīrṇē hitamitāśanaḥ| kāmalāpāṇḍuhr̥drōgavātāsr̥gviṣamajvarān||113|| kāsahikkāruciśvāsāṁścaiṣō'riṣṭaḥ praṇāśayēt| iti dhātryariṣṭaḥ| dhAtrIphalasahasre dve pIDayitvA rasaM tu tam||111|| kShaudrAShTAMshena saMyuktaM kRuShNArdhakuDavena ca| sharkarArdhatulonmishraM pakShaM snigdhaghaTe sthitam||112|| prapibenmAtrayA prAtarjIrNe hitamitAshanaH| kAmalApANDuhRudrogavAtAsRugviShamajvarAn||113|| kAsahikkArucishvAsAMshcaiSho~ariShTaH praNAshayet| iti dhAtryariShTaH| Dhātryariśṭa - Two thousand fruits of amalakī should be crushed and the juice extracted should be mixed with one eighth the quantity of honey, half kuḍava of pippalī and half tulā of sugar. It should then be kept in an earthern jar smeared with ghee for one fortnight. It should be taken in appropriate dose in the morning and the patient should take wholesome food in small quantity after the digestion of the drug. This arisṭa cures kāmalā, pāndu, hṛdroga, vātarakta , viṡama jwara, kāsa, hikkā, aruci and svāsa. Thus, ends the description of dhātrya ariśṭa (111-113). Medicated water: स्थिरादिभिः शृतं तोयं पानाहारे प्रशस्यते||११४|| पाण्डूनां, कामलार्तानां मृद्वीकामलकीरसः|११५| sthirādibhiḥ śr̥taṁ tōyaṁ pānāhārē praśasyatē||114|| pāṇḍūnāṁ, kāmalārtānāṁ mr̥dvīkāmalakīrasaḥ|115| sthirAdibhiH shRutaM toyaM pAnAhAre prashasyate||114|| pANDUnAM, kAmalArtAnAM mRudvIkAmalakIrasaH|115| Water boiled with the drugs belonging to sthirādi group is useful for drinking and the preparation of foods for pāndu rogi; while the patient of kāmalā should use the juice of drākṡā and amalakī rasa (114-115). Principles of treatment according to doṣha: पाण्डुरोगप्रशान्त्यर्थमिति प्रोक्तं महर्षिणा||११५|| विकल्प्यमेतद्भिषजा पृथग्दोषबलं प्रति| वातिके स्नेहभूयिष्ठं, पैत्तिके तिक्तशीतलम्||११६|| श्लैष्मिके कटुतिक्तोष्णं [१] , विमिश्रं सान्निपातिके|११७| pāṇḍurōgapraśāntyarthamiti prōktaṁ maharṣiṇā||115|| vikalpyamētadbhiṣajā pr̥thagdōṣabalaṁ prati| vātikē snēhabhūyiṣṭhaṁ, paittikē tiktaśītalam||116|| ślaiṣmikē kaṭutiktōṣṇaṁ [1] , vimiśraṁ sānnipātikē|117| pANDurogaprashAntyarthamiti proktaM maharShiNA||115|| vikalpyametadbhiShajA pRuthagdoShabalaM prati| vAtike snehabhUyiShThaM, paittike tiktashItalam||116|| shlaiShmike kaTutiktoShNaM [1] , vimishraM sAnnipAtike|117| The above mentioned drugs are described for the cure of pāndu roga by the great sage (Punarvasu Ātreya). The physician should make suitable changes (combinations and permutations) in the above 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 (115-117). Treatment of mrittikā bhakṡaṇa janya pāndu: निपातयेच्छरीरात्तु मृत्तिकां भक्षितां भिषक्||११७|| युक्तिज्ञः शोधनैस्तीक्ष्णैः प्रसमीक्ष्य बलाबलम्| शुद्धकायस्य सर्पींषि बलाधानानि योजयेत्||११८|| व्योषं बिल्वं हरिद्रे द्वे त्रिफला द्वे पुनर्नवे| मुस्तान्ययोरजः पाठा विडङ्गं देवदारु च||११९|| वृश्चिकाली च भार्गी च सक्षीरैस्तैः [१] समैर्घृतम्| साधयित्वा पिबेद्युक्त्या नरो मृद्दोषपीडितः||१२०|| तद्वत् केशरयष्ट्याह्वपिप्पलीक्षारशाद्वलैः| मृद्भक्षणादातुरस्य लौल्यादविनिवर्तिनः||१२१|| द्वेष्यार्थं भावितां कामं दद्यात्तद्दोषनाशनैः| विङ्गैलातिविषया निम्बपत्रेण पाठया||१२२|| वार्ताकैः कटुरोहिण्या कौटजैर्मूर्वयाऽपि वा|१२३| nipātayēccharīrāttu mr̥ttikāṁ bhakṣitāṁ bhiṣak||117|| yuktijñaḥ śōdhanaistīkṣṇaiḥ prasamīkṣya balābalam| śuddhakāyasya sarpīṁṣi balādhānāni yōjayēt||118|| vyōṣaṁ bilvaṁ haridrē dvē triphalā dvē punarnavē| mustānyayōrajaḥ pāṭhā viḍaṅgaṁ dēvadāru ca||119|| vr̥ścikālī ca bhārgī ca sakṣīraistaiḥ [1] samairghr̥tam| sādhayitvā pibēdyuktyā narō mr̥ddōṣapīḍitaḥ||120|| tadvat kēśarayaṣṭyāhvapippalīkṣāraśādvalaiḥ| mr̥dbhakṣaṇādāturasya laulyādavinivartinaḥ||121|| dvēṣyārthaṁ bhāvitāṁ kāmaṁ dadyāttaddōṣanāśanaiḥ| viṅgailātiviṣayā nimbapatrēṇa pāṭhayā||122|| vārtākaiḥ kaṭurōhiṇyā kauṭajairmūrvayā'pi vā|123| nipAtayeccharIrAttu mRuttikAM bhakShitAM bhiShak||117|| yuktij~jaH shodhanaistIkShNaiH prasamIkShya balAbalam| shuddhakAyasya sarpIMShi balAdhAnAni yojayet||118|| vyoShaM bilvaM haridre dve triphalA dve punarnave| mustAnyayorajaH pAThA viDa~ggaM devadAru ca||119|| vRushcikAlI ca bhArgI ca sakShIraistaiH [1] samairghRutam| sAdhayitvA pibedyuktyA naro mRuddoShapIDitaH||120|| tadvat kesharayaShTyAhvapippalIkShArashAdvalaiH| mRudbhakShaNAdAturasya laulyAdavinivartinaH||121|| dveShyArthaM bhAvitAM kAmaM dadyAttaddoShanAshanaiH| vi~ggailAtiviShayA nimbapatreNa pAThayA||122|| vArtAkaiH kaTurohiNyA kauTajairmUrvayA~api vA|123| A physician well versed in therapeutics, should give the patient strong elimination therapy, keeping in view the strength of the patient, in order to remove the swallowed mud from the body. After the body is cleansed, different types of medicated ghee should be prescribed to the patient for promotion of strength. Ghee prepared with sunṭhī, pippali, maricha, bilva, haridrā, dāruharidrā, harītakī, bibhītaka, amalakī, sveta and rakta punarnavā, mustā, lauha bhasma, pāthā, vydanga, devadāru, vṛścikālī, bhārgī and milk should be appropriately taken by the patient who suffers from anemia because of swallowing clay. Likewise, ghee prepared with keśara, yaśtmadhu, pippali, kṡāra (alkali preperation) and sadvāla may be given to the patient suffering from mritikā bhakśaṇa janya pāndu. If the paient is unable to give up his clay swallowing habits, he should be given clay impregnated with viḍanga, elā, ativiśā, neem leaves, pāṭhā, varātaka, kaṭurohiṇī, kuṭaja or mūrvā with a view of creating an aversion to clay. These drugs also counter act the adverse effects of clay swallowing (117-123).

यथादोषं प्रकुर्वीत भैषज्यं पाण्डुरोगिणाम्||१२३|| क्रियाविशेष एषोऽस्य मतो हेतुविशेषतः|१२४| yathādōṣaṁ prakurvīta bhaiṣajyaṁ pāṇḍurōgiṇām||123|| kriyāviśēṣa ēṣō'sya matō hētuviśēṣataḥ|124| yathAdoShaM prakurvIta bhaiShajyaM pANDurogiNAm||123|| kriyAvisheSha eSho~asya mato hetuvisheShataH|124| Different types of treatment should be given to the patient suffering from mrittikā bhakśaṇa janya pāndu, according to the different types of dośha aggravated. However, due to the specific type of aetiological factor involved (clay eating), this type of pandu needs special type of treatment (123-124). Śākhāśrita kāmala (kamala in body tissue with obstructive pathology): तिलपिष्टनिभं यस्तु वर्चः सृजति कामली||१२४|| श्लेष्मणा रुद्धमार्गं तत् पित्तं कफहरैर्जयेत्| रूक्षशीतगुरुस्वादुव्यायामैर्वेगनिग्रहैः||१२५|| कफसम्मूर्च्छितो वायुः स्थानात् पित्तं क्षिपेद्बली| हारिद्रनेत्रमूत्रत्वक् श्वेतवर्चास्तदा नरः||१२६|| भवेत् साटोपविष्टम्भो गुरुणा हृदयेन च| दौर्बल्याल्पाग्निपार्श्वार्तिहिक्काश्वासारुचिज्वरैः||१२७|| क्रमेणाल्पेऽनुसज्येत [१] पित्ते शाखासमाश्रिते|१२८| tilapiṣṭanibhaṁ yastu varcaḥ sr̥jati kāmalī||124|| ślēṣmaṇā ruddhamārgaṁ tat Pittaṁ Kaphaharairjayēt| rūkṣaśītagurusvāduvyāyāmairvēganigrahaiḥ||125|| Kaphasammūrcchitō vāyuḥ sthānāt Pittaṁ kṣipēdbalī| hāridranētramūtratvak śvētavarcāstadā naraḥ||126|| bhavēt sāṭōpaviṣṭambhō guruṇā hr̥dayēna ca| daurbalyālpāgnipārśvārtihikkāśvāsārucijvaraiḥ||127|| kramēṇālpē'nusajyēta [1] pittē śākhāsamāśritē|128| tilapiShTanibhaM yastu varcaH sRujati kAmalI||124|| shleShmaNA ruddhamArgaM tat pittaM kaphaharairjayet| rUkShashItagurusvAduvyAyAmairveganigrahaiH||125|| kaphasammUrcchito vAyuH sthAnAt pittaM kShipedbalI| hAridranetramUtratvak shvetavarcAstadA naraH||126|| bhavet sATopaviShTambho guruNA hRudayena ca| daurbalyAlpAgnipArshvArtihikkAshvAsArucijvaraiH||127|| krameNAlpe~anusajyeta [1] pitte shAkhAsamAshrite|128| A patient of kāmalā if passes stools of the colour of sesame paste (tila piśṭa nibhama), then it denotes obstruction in the passage of pitta by the kapha. Therefore, the pitta of such patient should be won by administration of drugs which also eliminate kapha. The excess usage of ununctuous, cold and sweet ingredients; excessive exercise; suppression of the natural urges leads to the the aggravation of vāta infilterated with kapha and the displacement of pitta from its site, resulting in the development of the following features: The eyes, skin and urine of the patient become yellow while his stools become white in colour. Additionally, the patients suffer from aṭopa (tympanitis), viśṭambha (constipation associated with flatulence),and heaviness in the cardiac region, due to the displacement of pitta in the peripheral tissues (shākhā), there is diminution in the flow of pitta (to the gastrointestinal tract) resulting in the gradual development of weakness, agnimāndya (low digestion), pārśva (pain in the sides of chest), hikkā (hiccup), shvāsa (dysnoea), aruchi (anorexia) and jwara (124-128).

Treatment of sākhāśriat kāmala:

बर्हितित्तिरिदक्षाणां रूक्षाम्लैः कटुकै रसैः||१२८|| शुष्कमूलककौलत्थैर्यूषैश्चान्नानि भोजयेत्| मातुलुङ्गरसं क्षौद्रपिप्पलीमरिचान्वितम्||१२९|| सनागरं पिबेत् पित्तं तथाऽस्यैति स्वमाशयम्|१३०| barhitittiridakṣāṇāṁ rūkṣāmlaiḥ kaṭukai rasaiḥ||128|| śuṣkamūlakakaulatthairyūṣaiścānnāni bhōjayēt| mātuluṅgarasaṁ kṣaudrapippalīmaricānvitam||129|| sanāgaraṁ pibēt Pittaṁ tathā'syaiti svamāśayam|130| barhitittiridakShANAM rUkShAmlaiH kaTukai rasaiH||128|| shuShkamUlakakaulatthairyUShaishcAnnAni bhojayet| mAtulu~ggarasaM kShaudrapippalImaricAnvitam||129|| sanAgaraM pibet pittaM tathA~asyaiti svamAshayam|130| The patient suffering from from shākhāśṛita kāmalā should be given food along with the soup of the meat of peacock, tittira (partridge), dakṡa (cock) sizzled with ununctuous, sour and pungent articles; and vegetable soups of dry mūlaka (radish) and kulattha. The patient should also be given the juice of mātulunga mixed with honey, pippalī, marīca and sunthī for bringing the pitta to its own course (128-130).

कटुतीक्ष्णोष्णलवणैर्भृशाम्लैश्चाप्युपक्रमः||१३०|| आपित्तरागाच्छकृतो [१] वायोश्चाप्रशमाद्भवेत्| स्वस्थानमागते पित्ते पुरीषे पित्तरञ्जिते||१३१|| निवृत्तोपद्रवस्य स्यात् पूर्वः कामलिको विधिः|१३२| kaṭutīkṣṇōṣṇalavaṇairbhr̥śāmlaiścāpyupakramaḥ||130|| āPittarāgācchakr̥tō [1] vāyōścāpraśamādbhavēt| svasthānamāgatē pittē purīṣē Pittarañjitē||131|| nivr̥ttōpadravasya syāt pūrvaḥ kāmalikō vidhiḥ|132| kaTutIkShNoShNalavaNairbhRushAmlaishcApyupakramaH||130|| ApittarAgAcchakRuto [1] vAyoshcAprashamAdbhavet| svasthAnamAgate pitte purIShe pittara~jjite||131|| nivRuttopadravasya syAt pUrvaH kAmaliko vidhiH|132| Katu (pungent), tīkṡṇa (sharp), uśṇa (hot), lavaṇa (saline) and extremely amla (sour) drugs should be continued till the stool of the patient acquires the colour of pitta and the vāta gets alleviated. When the pitta returns to its own habitat, the stool gets coloured with pitta and the patient is relieved of complications, then further, the line of treatment described earlier for the treatment of kāmalā (kośṭhāśṛta) should be used (130-132). Halīmaka (obstructive jaundice): यदा तु पाण्डोर्वर्णः स्याद्धरितश्यावपीतकः||१३२|| बलोत्साहक्षयस्तन्द्रा मन्द्राग्नित्वं मृदुज्वरः| स्त्रीष्वहर्षोऽङ्गमर्दश्च श्वासस्तृष्णाऽरुचिर्भ्रमः||१३३|| हलीमकं तदा तस्य विद्यादनिलपित्ततः|१३४| yadā tu pāṇḍōrvarṇaḥ syāddharitaśyāvapītakaḥ||132|| balōtsāhakṣayastandrā mandrāgnitvaṁ mr̥dujvaraḥ| strīṣvaharṣō'ṅgamardaśca śvāsastr̥ṣṇā'rucirbhramaḥ||133|| halīmakaṁ tadā tasya vidyādanilaPittataḥ|134| yadA tu pANDorvarNaH syAddharitashyAvapItakaH||132|| balotsAhakShayastandrA mandrAgnitvaM mRudujvaraH| strIShvaharSho~a~ggamardashca shvAsastRuShNA~arucirbhramaH||133|| halImakaM tadA tasya vidyAdanilapittataH|134| If a patient suffering from pāndu develops green, black or yellow colour and suffers from diminution of strength and enthusiasm; drowsiness, agnimāndya (low digestiion), mild fever, lack of libido (stṛsu aharśo), angamarda (malaise/ body ache), dyspnoea, triśṇā (morbid thirst), anorexia and giddiness, the ailment is called halīmaka and is caused by the aggravation of vāta and pitta dośha (132-134). Treatment of halīmaka: गुडूचीस्वरसक्षीरसाधितं माहिषं घृतम्||१३४|| स पिबेत्त्रिवृतां स्निग्धो रसेनामलकस्य तु| विरिक्तो मधुरप्रायं भजेत् पित्तानिलापहम्||१३५|| द्राक्षालेहं च पूर्वोक्तं सर्पींषि मधुराणि च| यापनान् क्षीरबस्तींश्च शीलयेत्सानुवासनान्||१३६|| मार्द्वीकारिष्टयोगांश्च पिबेद्युक्त्याऽग्निवृद्धये| कासिकं चाभयालेहं पिप्पलीं मधुकं बलाम्||१३७|| पयसा च प्रयुञ्जीत यथादोषं यथाबलम्|१३८| guḍūcīsvarasakṣīrasādhitaṁ māhiṣaṁ ghr̥tam||134|| sa pibēttrivr̥tāṁ snigdhō rasēnāmalakasya tu| viriktō madhuraprāyaṁ bhajēt pittānilāpaham||135|| drākṣālēhaṁ ca pūrvōktaṁ sarpīṁṣi madhurāṇi ca| yāpanān kṣīrabastīṁśca śīlayētsānuvāsanān||136|| mārdvīkāriṣṭayōgāṁśca pibēdyuktyā'gnivr̥ddhayē| kāsikaṁ cābhayālēhaṁ pippalīṁ madhukaṁ balām||137|| payasā ca prayuñjīta yathādōṣaṁ yathābalam|138| guDUcIsvarasakShIrasAdhitaM mAhiShaM ghRutam||134|| sa pibettrivRutAM snigdho rasenAmalakasya tu| virikto madhuraprAyaM bhajet pittAnilApaham||135|| drAkShAlehaM ca pUrvoktaM sarpIMShi madhurANi ca| yApanAn kShIrabastIMshca shIlayetsAnuvAsanAn||136|| mArdvIkAriShTayogAMshca pibedyuktyA~agnivRuddhaye| kAsikaM cAbhayAlehaM pippalIM madhukaM balAm||137|| payasA ca prayu~jjIta yathAdoShaM yathAbalam|138| Patients suffering from halīmaka should take the recipe prepared from buffalo ghee by adding the juice of guḍūchī and milk. After oleation with this oil the patient should take trivṛta mixed with the juice of amalakī which causes purgation. Thereafter food and drinks which are dominated by sweet taste and are alleviators of pitta and kapha should be given. The patient should take drākṡāleha described earlier (vide verse 100-102 in this chapter in the name of dhātryavaleha) and recipes of medicated ghee prepared by boiling with sweet drugs (vide verse 51 -52). The patient should habitually indulge in taking different types of yāpanā bastī (a type of medicated enema), kṡāra bastī and anuvāsana bastī (discussed in Siddhī Sthāna). He should also take different recipes of ariśṭa prepared from grapes (drākṡāriṡṭa) for the promotion of power of digestion. Abhayā leha described in the treatment of kāsa (Cha Chi. 18/57-62) may also be taken. Alternatively the patient may also take pippalli, madhūka and balā along with milk depending upon the dośhās aggravated and the strength of the patient (134-138). Summary: तत्र श्लोकौ- पाण्डोः पञ्चविधस्योक्तं हेतुलक्षणभेषजम्||१३८|| कामला द्विविधा तेषां साध्यासाध्यत्वमेव च| तेषां विकल्पो यश्चान्यो महाव्याधिर्हलीमकः| तस्य चोक्तं समासेन व्यञ्जनं सचिकित्सितम्||१३९|| tatra ślōkau- pāṇḍōḥ pañcavidhasyōktaṁ hētulakṣaṇabhēṣajam||138|| kāmalā dvividhā tēṣāṁ sādhyāsādhyatvamēva ca| tēṣāṁ vikalpō yaścānyō mahāvyādhirhalīmakaḥ| tasya cōktaṁ samāsēna vyañjanaṁ sacikitsitam||139|| tatra shlokau- pANDoH pa~jcavidhasyoktaM hetulakShaNabheShajam||138|| kAmalA dvividhA teShAM sAdhyAsAdhyatvameva ca| teShAM vikalpo yashcAnyo mahAvyAdhirhalImakaH| tasya coktaM samAsena vya~jjanaM sacikitsitam||139|| To sum up, the topics discussed in this chapter are – • Five types of pāndu along with the etiology, signs and symptoms; and treatment • Two types of kāmalā and their curability as well as incurability • Different varieties of kāmalā • Halīmaka, which is a serious disease along with its signs and symptoms; and treatment (138-139). Shloka – इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने पाण्डुरोगचिकित्सितं नाम षोडशोऽध्यायः||१४0|| ityagnivēśakr̥tē tantrē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē pāṇḍurōgacikitsitaṁ nāma ṣōḍaśō'dhyāyaḥ||140|| ityagniveshakRute tantre~aprApte dRuDhabalasampUrite cikitsAsthAne pANDurogacikitsitaM nAma ShoDasho~adhyAyaH||16|| Thus ends the sixteenth chapter in Cikitsā Sthāna dealing with the treatment of pāndu roga in the work of Agniveśa which was redacted by Caraka and because of its unavailability was supplemented by Dṛḍhabala (140). Tattva vimarsha: • 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, niśpāva (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. • Heart and circulatory system are involved in the pathogenesis of pandu which is presented at the sites of skin and mānsa (flesh). • 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. • Chronic pāndu 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. • 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. • 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 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. • 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. • 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. Vidhi vimarsha: Current clinical practices in treatment of pandu and kamala ( referred from Chikitsa pradeep): Type Medicine Dose Time Anupana Vata dominant pandu Mahayogaraja samira mixture 120-480 mg After meals Ghee ( dadimadi) + honey Tiktaka ghritam 10-40 ml After meals Hot water Navajivana rasa 120-200 mg After meals Milk Pitta dominant pandu Tapyadi loha mixture 250-600 mg After meals Dadimadi ghee + udumbaravaleha Vasadi decoction 20-40 ml After meals Honey Kapha dominant pandu Gomutra haritaki mixture 600 mg – 3 grams After meals Honey + juice of castor leaves Mruttika bhakshana janya Gomutra haritaki mixture 600 mg – 3 grams After meals Kumari asava Ruddha patha kamala Icchha bhedi rasa 120-180 mg Early morning one time Lemon juice Suta shekhara kalpa 120-250 mg After meals Milk + sugar Koshta ashrita kamala As like pitta dominant pandu

Research studies on pandu: Some studies are available on the net which prove the efficacy of various Āyurvedic drugs having iron (in the form of lauha and mandura) compounds in the management of iron deficiency anemias – 1. Kumath V. A Comprehensive Study of Haritaki with Special Reference to the Efficacy of Terminalia chebula Retz. On Pāndu Roga, MD thesis. P. G. Department. of Dravyaguna,Government. Ujjain, Madhya Pradesh: Autonomous Dhanvantari Ayurveda College and Hospital; 2006. 2. Agrawal N. Assessment of Effect of Mandura Bhasma in Iron Deficiency Anemia in Children, MD thesis. P.G. Department of Kaumarbhritya. Varanasi: IMS, B.H.U; 2007. 3. Sarkar PK, Prajapati PK, Choudhary AK, Shukla VJ, Ravishankar B. Haematinic Evaluation of Lauha Bhasma and Mandura Bhasma on HgCl2-induced Anemia in Rats. Indian J Pharm Sci 2007;69:791-5. 4. Sarkar PK. A Comparative Pharmaceutico-pharmaco-clinical study of Lauha Bhasma and Mandura Bhasma w.s.r. to its Pāndu-hara Effect, MD thesis. I.P.G.T. & R.A. Jamnagar: Gujrat Ayurveda University; 2005. 5. Garai A, Rai M, Kumar A. Role of an Ayurvedic Compound (Pānduhara Yoga) in the Management of Iron Deficiency Anaemia in Children. Ayu 2009;30:469-74. 6. Gupta V, Reddy KR. Experimental Studies of Lohasava. Aryavaidyan 2007;21:87-94. 7. Joshi N. Pharmaceutical, Pharmacological and Toxicological Study of Various Lauha Preparations(Kalpa) w.s.r. to Iron Deficiency Anaemia, M.D. Thesis. P. G. Department of Rasa Shastra and Bhaishajya Kalpana, Jaipur: N.I.A; 2005. 8. Sarkar PK, Prajapati PK, Shukla VJ, Ravishankar B, Choudhary AK. Toxicity and recovery studies of two Ayurvedic preparations of iron. Indian J Exp Biol 2009;47:987-92. 9. Devarshi P, Kanse A, Kanse R, Mane S, Patil S, Varute AT. Effect of Mandura Bhasma on lipolytic Activities of Liver, Kidney and Adipose Tissue of Albino Rat During CCl4 Induced hepatic Injury. J Biosci 1986;10:227-34. 10. Pandit S, Biswas TK, Debnath PK, Saha AV, Chowdhury U, Shaw BP, et al. Chemical and pharmacological evaluation of different Ayurvedic preparations of iron. J Ethnopharmacology 1999;65:149-56. 11. Dinesh C. Sharma, Deepa Chandiramani, Manminder Riyat and Praveen Sharma. Scientific evaluation of some ayurvedic preparations for correction of iron deficiency and anemia. Indian Journal of Clinical Biochemistry, 2007 / 22 (2) 123-128 12. Ambika Das, PA03.17. A clinical evaluation of Punarnavadi Mandura and Dadimadi Ghritha in management of Pāndu (Iron defeciency anaemia), Ancient Science of Life 2013; 32 (s2):86

One of the studies (no. 11) even reports that the Āyurvedic preperations were found equally effective as the allopathic compound in the management of iron deficiency anemia and the fact that the side effects were almost nil establishes them to be even superior. The modes of action of drugs and procedures as stated in this chapter, which is without iron, have not been studied much in anemias. Though, some of the preperations described in anemia have been found very useful in the management of other types of anemias as sickle cell anemia , aplastic anemia etc. So, further studies need to be done in order to know the efficacy of these drugs and mechanisms in the various types of anemias.

Principle of treatment for kāmalā:

The management of kāmala by the drugs stated in the chapter has been found to show good results but the mechanism of their action is still not clear. Practically few studies are available on the net which prove the efficacy of Āyurvedic compounds in the management of hepatocellular jaundice as – • Nirmal kumar* and anil kumar singh. Phalatrikadi kvatha - an ayurvedic hepatoprotective drug. International journal of research in pharmacy and chemistry.2013, 3(3) Available online at www.ijrpc.com

References