चतुश्चत्वारिंशोऽध्यायः अथातः पाण्डुरोगप्रतिषेधं व्याख्यास्यामः, यथोवाच धन्वन्तरिः ॥ १ ॥ भगवान्
Now we shall discourse on the chapter which deals with the ( symptoms and) medical treatment of Anaemia, etc. (Pandu-roga Pratisedha). 1
Etiology and Nomenclature of Pandu Roga
व्यवायमम्लं लवणानि मद्यं मृदं दिवास्वप्नमतीव तीक्ष्णम् । निषेवमाणस्य विदूष्य रक्तं कुर्वन्ति दोषास्त्वचि पाण्डुभावम् ॥ २ ॥ पाण्ड्वामयोऽष्टार्धविधः प्रदिष्टः पृथक् समस्तैर्युगपच्च दोषैः । सर्वेषु चैतेष्विह पाण्डुभावो यतोऽधिकोऽतः खलु पाण्डुरोगः ॥ ३ ॥
Etiology and Nomenclature – The deranged bodily Dosas of a person addicted to sexual excesses¹ or to eating clay or salts or articles of keen potency and of acid or saline taste or to strong liquors in excessive quantlies or to sleeping in the day, contaminate the blood and produce a yellowish (Pandu) colour of the skin. This is known as Pandu-roga and is divided into four distinct types² according as they are separetely originated through the action of the deranged Vata, Pitta, or Kapha the fourth being the one incidental to their concerted action.
The disease has got the name of Pandu-roga from the fact that a deep yellow (Pandu) colour is imparted to the skin of the patient suffering there from. 2-3.
1. Madhava in his Nidana reads “Vyayama ” (physical exercise) in the place of
“Vyavaya” in the long list of the causes of Pandu-roga. 2. A variant reads that Pandu-roga is of eight kinds. In that case the four different varieties of Pandu, separately mentioned below should be added to the four kinds mentioned here. Caraka says that Pandu-roga is of five different types- by separating and adding the one due to the eating of clay to the four kinds enumerated here.
Premonitory symptoms of Pandu Roga
त्वक्स्फोटनं ष्ठीवनगात्रसादौ मृद्धक्षणं प्रेक्षणकूटशोथाः । विण्मूत्रपीतत्वमथाविपाको भविष्यतस्तस्य पुरःसराणि ॥ ४ ॥ सकामलापानकिपाण्डुरोगः कुम्भाह्वयो लाघर (व)कोऽलसाख्यः । विभाष्यते लक्षणमस्य कृत्स्नं निबोध वक्ष्याम्यनुपूर्वशस्तम् ॥ ५ ॥
Premonitory symptoms – Cracking of the skin, salivation (spitting ) a sense of lassitude in the limbs, ( desire for ) eating clay, swelling of the eyelids, yellow colour of stool and urine, and indigestion are the premonitory symptoms which usher in an attack of Panduroga. The diseases known as Kamala-Panaki Pandu (popularly called Kamala), Kumbha-kamala, Lagharaka and Alasa (otherwise known as Halimaka) are all included within Jaundice (Pandu-roga), the characteristic symptoms of which are fully enumerated in succession below. 4-5.
Specific Symptoms of Pandu roga
कृष्णेक्षणं कृष्णसिरावनद्धं कृष्णसिरावनद्धं तद्वर्णविण्मूत्रनखाननञ्च । वातेन पाण्डुं मनुजं व्यवस्येद् युक्तं तथाऽन्यैस्तदुपद्रवैश्च ॥ ६ ॥ पीतेक्षणां पीतसिरावनद्धं तद्वर्णविण्मूत्रनखाननञ्च । पित्तेन पाण्डुं मनुजं व्यवस्येद् युक्तं तथाऽन्यैस्तदुपद्रवैश्च ॥ ७ ॥ शुक्लेक्षणं शुक्लसिरावनद्धं तद्वर्णविण्मूत्रनखाननञ्च। कफेन पाण्डुं मनुजं व्यवस्येद् युक्तं तथाऽन्यस्तदुपद्रवैश्च ॥ ८ ॥ सर्वात्मके सर्वमिदं व्यवस्येद् वक्ष्यामि लिङ्गान्यथ कामलायाः ॥ ९ ॥
Specific Symptoms – A black colour of the eyes and of the skin marked by the prominent appearance of black-coloured vein (on the surface), black colour of the stool and of the urine, blackness of face and of the finger-nails as well as other symptoms characteristic of the deranged bodily Vayu are manifested in the Vataja type of Pandu. Yellowness of the eyes and of the skin marked by the appearance of veins (Sira) of the same colour ( on its surface), yellownss of the stool and of the urine, yellowness of the face and fingernails and other specific symptoms of the deranged Pitta, mark the Pittaja type of the disease.
Whiteness of the eyes and of the skin, marked by the appearance of veins of the same colour (on its surface), whiteness of the stool and urine, whiteness of the face and of the finger-nails and other specific symptoms of the deranged Kapha mark a case of the Kaphaja type of the disease. All the preceding symptoms are exhibited in a case of the Sannipatika type. Now I shall describe the symptoms which mark the disease known as Kamala. 6-9.
यो ह्यामयान्ते सहसाऽन्नमम्लमद्यादपथ्यानि च तस्य पित्तम् । करोति पाण्डुं वदनं विशेषात् पूर्वेरितौ तन्द्रिबलक्षयौ च ॥ १० ॥
भेदस्तु तस्याः खलु कुम्भसाह्वः शोफो महांस्तत्र च पर्वभेदः ॥ ११ ॥
ज्वराङ्गमर्दभ्रमसादतन्द्रा – क्षयान्वितो लाघर ( व )कोऽलसाख्यः ॥ १२ ॥
तं वातपित्ताद्धरित्पीतनीलं हलीमकं नाम वदन्ति तज्ज्ञाः ॥ १३ ॥
The Pitta of a patient suffering form any disease not radically cured gets deranged by the use of any acid, or unwholesome food or drink, and imparts a (deep) yellow tint to his complexion and produces physical weakness as well as all the specific symptoms (of Panduroga) described above. This disease is known as Kamala. When it is accompanied by a general swelling (oedema) of the body and a crushing pain in the joints, is called Kumbha-Kamala, which, when it developes in its course such symptoms as fever, aching pain in the limbs, vertigo, physical langour, drowsiness and emaciation comes to be known as Lagharaka. This in its turn, when marked by an excessive preponderance of the deranged Vayu and Pitta is called Alasa, otherwise known as Halimaka, by those who are conversant with its, nature. 10-13.
उपद्रवास्तेष्वरुचिः पिपासाच्छर्दिज्वरो मूर्धरुजाऽग्निसादः । शोफस्तथा कण्ठगतोऽबलत्वं मूर्च्छा क्लमो हृद्यवपीडनञ्च ॥ १४ ॥Supervening Symptoms — Aversion to food, thirst, vomiting, fever, headache, dulness of digestive fire, swelling about the neck, weakness, epileptic fits, exhaustion and a pain in the region of the heart are included their distressing concomitants. 14.
General Treatment of Pandu Roga
साध्यन्तु पाण्ड्वामयिनं समीक्ष्य स्निग्धं घृतेनोर्ध्वमधश्च शुद्धम् । सम्पादयेत् क्षौद्रघृतप्रगाढैर्हरीतकीचूर्णयुतैः प्रयोगैः ॥ १५ ॥ पिबेद् घृतं वा रजनीविपक्वं यत् त्रैफलं तैल्वकमेव वाऽपि । विरेचनद्रव्यकृतं पिबेद्वा योगांश्च वैरेचनिकान् घृतेन ॥ १६ ॥ मूत्रे निकुम्भार्धपलं विपाच्य पिबेदभीक्ष्णं कुडवार्धमात्रम् । खादेद् गुडं वाऽप्यभयाविपक्वमारग्वधादिक्कथितं पिबेद् वा ॥ १७ ॥ अयोरजोव्योषविडंङ्गचूर्णं लिह्याद्धरिद्रां त्रिफलान्वितां वा । सर्पिर्मधुभ्यां विदधीत वाऽपि शास्त्रप्रदेशाभिहितांश्च योगान् ॥ १८ ॥
General Treatment – Having ascertained the curable nature of an attack of Pandu-roga, the patient should be treated with clarified butter’. He should then be purged and vomited with the compounds containing powdered Haritaki mixed with a copious quantity of honey and clarified butter. Clarified butter duly cooked with turmeric or the one known as Trai-phala-Ghrita² as well as the one known as Tailvaka Ghrita³ may also be used for the purpose. Drugs possessed of purgative properties should also be taken in combination with clarified butter (or clarified butter duly cooked with purgative drugs should be prescribed). Half a Pala (four Tolas) of Nikumbha duly cooked in an adequate quantity (eight Palas) of the urine of a she-buffalo should be daily used. Similarly half a Kudava measure of treacle mixed (D.R. duly cooked) with pulverised Haritaki should be taken by the patient. A decoction of the drugs of the Aragvadhadi group, may be likewise prescribed for internal use. Powdered (dead) iron mixed with pulverised Vyosa and Vidanga, or powdered Haridraª and Tri-phala should be licked up with honey and clarified butters. Any other medicinal compound mentioned anywhere as remedial to Gulma should also be administered. 15-18.
1. Some say that the Sneha used should be the Kalyanaka-Ghrita (Ch. LXII.). Others says that simply matured clarified butter should be used.
2. Traiphala-Ghrita may mean either the Ghrita duly cooked with Tri-phala or the one known as Traiphala-Ghrita mentioned in.
3. Similarly Tailvaka-Ghrita may mean the Ghrita of that name mentioned in Chap. V. Chikitsa-sthana or the one duly cooked with Tilvaka.
4. Here we have followed Dalhana in the text. Some take Haridra to mean DaruHaridra.
5. According to Caraka’s recipe, however, we find that the two compounds here have been combined into one and there we find the definite mention of Darvi (Daruharidra). In our practice also we follow Caraka in this case.
हरेच्च दोषान् बहुशोऽल्पमात्रान् श्वयेद्धि दोषेष्वतिनिर्हतेषु । धात्रीफलानां रसमिक्षुजञ्च मन्थं पिबेत् क्षौद्रयुतं हिताशी ॥ १९ ॥
The aggravated Dosas should be gradually eliminated from the system in as much as an quick and excessive elimination of the Dosas under the circumstances might produce swelling in the patient. Either the expresed juice of Dhatri or of the sugar-cane, or a Mantha¹ should be taken with honey by a patient and he should take wholesome diet. 19.
उभे बृहत्यौ रजनीं शुकाख्यां काकादनीञ्चापि सकाकमाचीम् । आदारिविम्बीं सकदम्बपुष्पीं विपाच्य सर्पिर्विपचेत् कषाये ॥ २० ॥ तत् पाण्डुतां हन्त्युपयुज्यमानं क्षीरेण वा मागधिकां यथाग्नि । हितञ्च यष्टीमधुकं कषायं चूर्णं समं वा मधुनाऽवलिह्यात् ॥ २१ ॥ गोमूत्रयुक्तं त्रिफलादलानां दत्त्वाऽऽयसं चूर्णमनल्पकालम् । प्रवालमुक्ताञ्जनशङ्खचूर्णं लिह्यात् तथा काञ्चनगैरिकोत्थम् ॥ २२ ॥
Clarified butter duly cooked with the Kalka and decoction of the two kinds of Brhati, Rajani, Sukakhya (Suka-simbi), Kakadani, Kakamaci, Adari-vimbi and Kadamba-puspi (Bhumi-Kadamba) should be taken as a remedy for Pandu-roga. Pippali-powder dissolved in milk should also be taken according to the condition of the appetite. The use of a decoction of Yasti-madhu, or of powdered Yasti-madhu mixed with honey would likewise prove efficacious. Powdered leaves of Tri-phala and powdered (dead) iron should be frequently taken as an electuary in combination with cow’s urine. A compound composed of powdered coral, pearl, antimony and conch-shell, or powdered Girimrttika (ferrugnious earth) should be similarly used by the patient. 20-22.
आजं शकृद वा कुडवप्रमाणं विडं हरिद्रा लवणोत्तमञ्च । पृथक्पलांशानि समग्रमेतच्चूर्णं हिताशी मधुनाऽवलिह्यात् ॥ २३ ॥
1. Mantha is prepared by mixing powdered grains of barley with clarified butter and a copious quantity of water. Some commentators, however, on the authority of other medical works, are of opinion that in cases of Pandu ( jaundice) the word “Mantha ” is technically used for the preparation of the powdered grains of barley mixed with the expressed juice of Amalaki and of sugar-cane and with honey.
मण्डूरलोहाग्निविडङ्गपथ्याव्योषांशकः सर्वसमानताप्यः । मूत्रासुतोऽयं मधुनाऽवलेहः पाण्ड्वामयं हन्त्यचिरेण घोरम् ॥ २४ ॥
A compound consisting of half a seer of powdered goat’s dung together with a Pala weight of each of the drugs known as Vit-salt, Haridra and Saindhava-salt, should be licked with honey by a patient living on wholesome diet. A compound of Mandura (iron-rust), Agni (Chitraka), Vidanga, Pathya, Tri-katu all taken in equal parts with Tapya (Svarna-maksika) equal to their combined weight should be duly soaked in cow’s urine and formed into a lambative with the addition of honey, the same being prescribed for an immediate cure of a serious type of Pandu-roga. 23-24.
बिभीतकायोमलनागराणां चूर्णं तिलानाञ्च गुडश्च मुख्यः । तक्रानुपानो वटका प्रयुक्तः क्षिणोति घोरानपि पाण्डुरोगान् ॥ २५ ॥ सौवर्चलं हिङ्गु किराततिक्तं कलायमात्राणि सुखाम्बुना वा । मूर्वाहरिद्रामलकञ्च लिह्यात् स्थितं गवां सप्त दिनानि मूत्रे ॥ २६ ॥
Bibhitaka, Mandura (iron-rust), Nagara and Tila should be pounded together and made into a paste with the addition of a profuse quantity of treacle. Pills prepared from this compound should be administered through the medium of Takra whereby a violent attack of jaundice would be defeated. Pills of the Kalaya weight of each of Sauvarcala, Hingu and Kirata-tikta pasted together, should be taken with tepid water. As an alternative, a lambative compound of Murva, Haridra and Amalaka pounded together and alternately dried and soaked in cow’s urine for a week, should be given to be licked by the patient. 25-26.
मूलं बलाचित्रकयोः पिबेद् वा पाण्ड्वामयार्तोऽक्षसमं हिताशी ॥ २७ ॥ सुखाम्बुना वा लवणेन तुल्यं शिग्रोः फलं क्षीरभुजोपयोज्यम् ॥ २८ ॥ न्यग्रोधवर्गस्य पिबेत् कषायं शीतं सिताक्षौद्रयुतं हिताशी । शालादिकञ्चाप्यथ सारचूर्णं धात्रीफलं वा मधुनाऽवलिह्यात् ॥ २९॥
A patient suffering from Pandu-roga should observe a proper regimen of diet and take two-Tola-weight of the compound of the powders of Bala and Chitraka ( with cow’s urine or tepid water). The compound of Saindhava salt and powdered Sigru-seeds taken in equal parts should be taken with tepid water, followed by a meal of cooked rice with milk. The decoction of the drugs of the Nyagrodhadi group should be taken, when cold, with honey and sugar followed by a proper regimen of diet. Powders of the drugs included within the Sala-saradi group or of Amalaka should be formed into a lambative with the addition of honey and given to be licked by the patient. 27-29.
विडङ्गमुस्तत्रिफलाजमोद-परूषकव्योषविनिर्दहन्यः । चूर्णीकृता वा गुडशर्करे च तथैव सर्पिर्मधुनी शुभे च ॥ ३० ॥ सम्भारमेतद् विपचेन्निधाय सारोदके सारवतो गणस्य | जातञ्च लेह्यं मतिमान् विदित्वा निधापयेन्मोक्षकजे समुद्रे ॥ ३१ ॥ हन्त्येष लेहः खलु पाण्डुरोगं सशोथमुग्रामपि कामलाञ्च ॥ ३२ ॥
The pulverised compound of Vidanga, Musta, Triphala, Ajamoda Parusaka, Vyosa and Chitraka as well as clarified butter, honey, sugar and treacle should be duly cooked in the decoction of the drugs of the Sala-saradi group till reduced to the consistency of a lambative. It should then be taken down and preserved inside a covered vessel prepared of Moksaka (Muskaka). This lambative proves curative in cases of Pandu attended with a general oedema as well as in cases of the violent types of Kamala. 30-32
Treatment of Kamala
सशर्करा कामलिनां त्रिभण्डी हिता गवाक्षी सगुडा च शुण्ठी । कालेयके चापि घृतं विपक्कं हितञ्च तत् स्याद्रजनीविमिश्रम् ॥ ३३ ॥ धातुं नदीजं जतुशैलजं वा कुम्भाह्वये मूत्रयुतं पिबेद् वा । मूत्रे स्थितं सैन्धवसम्प्रयुक्तं मासं पिबेद् वाऽपि हि लोहकिट्टम् ॥ ३४ ॥ दग्ध्वाऽक्षकाष्ठैर्मलमायसं वा गोमूत्रनिर्वापितमष्टवारान्। विचूर्ण्य लीढं मधुनाऽचिरेण कुम्भाह्वयं पाण्डुगदं निहन्यात् ॥ ३५ ॥
Treatment of Kamala etc. – Tribhandi (Trivrit ) taken with sugar as well as Gavaksi or Sunthi taken with treacle, is beneficial to a patient suffering from an attack of Kamala. Clarified butter duly cooked with Kaleya-wood and mixed with turmeric as an after-throw is also efficacious. In the alternative the patient should take Srotanjana and Silajatu with cow’s urine in a case of Kumbha-kamala Mandura (rust of iron) kept immerged in cow’s urine should be likewise taken with Saindhava-salt continually for a month. Mandura should be burnt in the fire of Bibhitaka wood and cooled with cow’s urine. The process should be repeated eight times in succession. The iron-rust thus tempered should be subsequently reduced to powders. Licked with honey it would act as a speedy cure in case of Kumbha-Kamala.33-35.
सिन्धूद्भवं वाऽग्निसमञ्च कृत्वा सिक्त्वा च मूत्रे सकृदेव तप्तम् । लौहञ्च किट्ट बहुशश्च तप्त्वा निर्वाप्य मूत्रे बहुशस्तथैव ॥ ३६ ॥ एकीकृतं गोजलपिष्टमेतदैकध्यमावाप्य पचेदुखायाम् । यथा न दह्येत तथा विशुष्कं चूर्णीकृतं पेयमुदश्विता तत् । तक्रौदनाशी विजयेत रोगं पाण्डुं तथा दीपयतेऽनलञ्च ॥ ३७ ॥ द्राक्षागुडूच्यामलकीरसैश्च सिद्धं घृतं लाघर ( च )के हितञ्च ॥ ३८ ॥
Saindhava-salt once made red-hot by heating (in the fire of Bibhitaka-wood) should be cooled in cow’s urine. Iron-rust ( Mandura) should be successively heated in fire and cooled with cow’s urine as directed above, the process being repeated many times. The two substances (Saindhava and iron-rust ) thus prepared, ( taken in equal parts) and made into a paste with (five times of) cow’s urine, should be cooked on an oven, care being taken to guard against their ignition. When dried, the compound should be reduced to powder and taken with Udasvit (a kind of Takra). The medicine acts as a good appetiser and proves curative in cases of Pandu. The patient using it should take his rice diet with Takra after the assimilation of the medicine. Clarified butter duly cooked with the expressed juice of Draksa, Guduci and amalaki proves curative in cases of Lagharaka. 36-38. ।
गौडानरिष्टान् मधुशर्कराश्च मूत्रासवान् क्षारकृतांस्तथैव स्निग्धान् रसानामलकैरुपेतान् कोलान्वितान् वाऽपि हि जाङ्गलानाम् । सेवेत शोफाभिहितांश्च योगान् पाण्ड्वामयी शालियवांश्च नित्यम् ॥ ३९ ॥
Articles of Diet— Aristas and Asavas prepared with treacle of with honey or with sugar or with cow’s urine or with Kshara (alkali) as well as the essence of meat of any Jangala animal saturated with clarified butter and mixed with the expressed juice of Amalaka or of Kola should be prescribed and meals of cooked barley grains or of Sali rice and the preparations prescribed in cases of swelling (Sopha) should be taken daily by a patient suffering from an attack of Pandu-roga. 39.
Treatment of supervening Symptoms of Pandu Roga
श्वासातिसारारुचिकासमूर्च्छातृछर्दिशूलज्वरशोफदाहान् तथाऽविपाकस्वरभेदसादान् जयेद् यथास्वं प्रसमीक्ष्य शास्त्रम् ॥ ४० ॥
Treatment of supervening Symptoms – The supervening symptoms such as difficulty of breathing, diarrhoea, aversion to food, cough, epileptic fits, thirst, vomiting, colic pain, fever, swelling ( Sopha), burning sensation in the body, indigestion, hoarseness lassitude, etc. should be remedied on the principles laid down in the Sastras with due regard to the nature and intensity of the deranged bodily Dosas, separately lying at their roots. 40.
अन्तेषु शूनं परिहीनमध्यं म्लानं तथाऽन्तेषु च मध्यशूनम् । गुदे च शेफस्यथ मुष्कशूनं प्रताम्यमानञ्च विसंज्ञकल्पम् । विवर्जयेत् पाण्डुकिनं यशोऽर्थी तथाऽतिसारज्वरपीडितञ्च ॥ ४१ ॥
Prognosis- If a patient afflicted with Pandu have an oedematous swelling of the extremities with an emaciation of the abdominal region and vice versa or if he has a swelling of the scrotum or of the genitals or about the anus or if he be suffering from fever or diarrhoea or be lying in a sub-comatose state, he should be given up and should not be attended by a physician caring anything for his fame. 41.
इति सश्रुत संहितायामुत्तरतन्त्रे पाण्डुरोगप्रतिषेधोनाम चतुश्चत्वारिंशोऽध्यायः ॥ ४४ ॥
Thus ends the forty-fourth chapter of the Uttara-Tantra in the Susruta Samhita which deals with the ( symptoms and) medical treatment of Pandu-roga.