E-ISSN:2456-3110

Research Article

Anaemia

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 2 February
Publisherwww.maharshicharaka.in

Study the efficacy of Murvadya Choorna Vati in Pandu Vyadhi with special reference to Iron Deficiency Anaemia

T. Kotangale Y.1*, V. Bhosle S.2
DOI: http://dx.doi.org/10.21760/jaims.8.2.6

1* Yogesh T. Kotangale, Ph.D. Scholar, Department of Kayachikitsa, Govt. Ayurved College, Vazirabad, Nanded, Maharashtra, India.

2 S V. Bhosle, Professor and Guide, Department of Panchakarma, Govt. Ayurved College, Vazirabad, Nanded, Maharashtra, India.

Rasa and Rakta Dhatus play very important role in our human life. Rasa and Rakta are considered as key factor for the nourishment and life maintenance of the body. In today’s world of urbanization and modern lifestyle, many times it is seen that higher economic class and lower economic class are all malnourished under different circumstances. These factors include fast food, low nutritional value food, stressful & hectic life, which in turn contribute to create very common and well-known disease Pandu. On the basis of similarity of aetiological factors and symptoms Pandu Vyadhi can be correlated with Anaemia. Anaemia is a decrease in the total amount of red blood cells or haemoglobin in the blood or a lowered ability of the blood to carry oxygen. It is caused due to number of causes including nutritional deficiencies, acute or slow blood loss due to trauma or disease, destruction of red blood cells due to various metabolic and immunological abnormalities or toxins, diseases of the bone marrow, general systemic diseases like infection and various varieties of cancer, kidney failure etc. In the present study, Murvadya Choorna Vati is described by Gada Nighraha in Pandu Vyadhi. Murvadya Choorna Vati contains Murva, Bala and Chitrak. Hence it is used in Pandu Vyadhi due to its Deepana, Pachana and Rasayana property.

Keywords: Pandu, Anaemia, Murvadya Choorna Vati, Deepana, Pachana

Corresponding Author How to Cite this Article To Browse
Yogesh T. Kotangale, Ph.D. Scholar, Department of Kayachikitsa, Govt. Ayurved College, Vazirabad, Nanded, Maharashtra, India.
Email: 		Yogesh T. Kotangale, S V. Bhosle, Study the efficacy of Murvadya Choorna Vati in Pandu Vyadhi with special reference to Iron Deficiency Anaemia. J Ayu Int Med Sci. 2023;8(2):39-45.
Available From
https://jaims.in/jaims/article/view/2278

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-26 2023-12-28 2023-01-05 2023-01-12 2023-01-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Yogesh T. Kotangale, S V. Bhosleand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Kotangale Y et al: Murvadya Choorna Vati in Pandu Vyadhi to Iron Deficiency Anaemia

Introduction

Anaemia is a global public health problem affecting both developing and developed countries like India. It occurs at all stages of life cycle; but it is more prevalent in children and women of reproductive age groups.[1] Among the different types of anaemia, Iron deficiency anaemia (IDA) is the most common cause of Anaemia globally. IDA constitutes for 75% of total Anaemia cases. IDA has various causes like impairment of RBCs production, nutritional deficiency and systemic disorders in developing countries.[2]

On the basis of similarity of aetiological factors and symptoms, it can be correlated with Anaemia. The name is derived from Ancient Greek word ‘anaimia’ meaning “lack of blood.”

The prevalence of the disease is abundant especially in India. In modern medicine, many therapies are available. Many oral haematinics, parentral iron and Vit. B12 preparations and in some severe cases of anaemia blood transfusion will be needed. Though these therapies have significant results, it is only for acute Anaemia. But for chronic anaemia which occur due to metabolic defects, no notable therapy is available. Also, haematinics which have best effects has some side effects like constipation, gastritis, flatulence etc. Ayurveda can provide better management this kind of side effects.[3]

Iron deficiency anemia is one of the most common nutritional deficiencies[4] It is Pitta dominant Tridoshaja disease where discoloration of skin occurs due to Alpa Rakta (reduced blood) or Dushita Rakta (vitiated blood). Pandu Vyadhi is mainly included under ‘Santarpanjanya Vikara.[5]

Iron Deficiency Anemia is thought to be the most common cause of Anemia globally as well as in our country.[6] Its prevalence varies widely in different parts of the world. It is the commonest disorder all over the world and forms a major problem of mankind, especially in a developing country like India due to low socio-economic status, illiteracy and malnutrition in a major part of the population.[7] It affects the physical and mental health.[8]

The main goal for treating anemia is iron supplementation without correcting the metabolism. However, besides the lack of iron in diet, one of the main reasons of IDA is poor absorption of iron, which needs correction at the primary level.

Haemoglobin is known to naturally vary according to age, sex as well as physiological status like pregnancy.[9] Thus, a haemoglobin concentration below established specific cut-off values is indicative of anaemia. Although a moderate degree of anaemia may not affect every day work, it has massive impact on those engaged in heavy physical activity. The consequences of anaemia among women include reduced energy and capacity for work and poor pregnancy outcome that further enhances maternal mortality (Levin et al., 1993).[10]

Rasavaha Srotas is the predominant Srotas to be vitiated in Pandu Vyadhi which is a Rasapradoshaja Vikara where in due to Aharaj and Viharaj Hetu, Rasa Dhatu formation is hampered.[11] In Pandu Vyadhi, there is vitiation of Tridosha with predominance of Pitta Dosha. Sadhak Pitta and Vyan Vayu are mainly involve as both these reside in Hrudaya. These vitiated Doshas affect Rasa Dhatu which is circulated all over the body through Dash Dhamani by the influence of Vyan Vayu. This Dushta Rasa Dhatu gets Sthanasanshraya in between the Twacha and Mamsa. Further vitiation of Kapha and Vata Dosha, and Rakta and Mamsa Dhatu lead in manifestation of Pandu Vyadhi.[12]

Hence, the present study with Murvadya Choorna Vati has been undertaken to evaluate the efficacy on the basis of subjective and objective parameters and also to find a cost-effective treatment for Pandu Vyadhi.

Primary Objective

To study the efficacy of Murvadya Choorna Vati in Pandu Vyadhi with special reference to Iron Deficiency Anaemia.

Secondary Objectives

To evaluate the effect of Murvadya Choorna Vati in Pandu Vyadhi with special reference to Iron Deficiency Anaemia on the basis of cardinal symptoms and changes in Haemoglobin and Sr. Iron level.

Murvadya Choorna Vati[13]

Murvadya Choorna Vati is mentioned in Gada Nigraha in Pandu Adhyaya. Its contents are Murva (Marsdenia tenacissima), Bala (Sida cordifolia) and Chitrak (Plumbago zeylanica). Roots of Murva, Bala and Chitrak are taken in Choorna


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Kotangale Y et al: Murvadya Choorna Vati in Pandu Vyadhi to Iron Deficiency Anaemia

form and in equal amounts and are converted to tablet form for the convenience and proper dosage of the patients. All these drugs have a combined synergistic action.

Murva[14]

  • Latin name - Marsdenia tenacissima
  • Family - Asclepiadeceae
  • Synonyms - Maruabel, Moravela, Tiktavalli, Jartor.
  • Rasa - Tikta, Madhur, Kashaya
  • Vipaka - Katu
  • Veerya - Ushna
  • Doshaghnata - Tridosha shamak
  • Rogaghnata - Murva is useful in Kapha, Vata and Paitik Vikaras It is used in Twaka Vikara, Aamdosha, Amlapitta, Vibandha, Kamala, Shoola, Krimi, Hridaya Vikaras, Rakta Vikaras, Prameha, Kushtha, Vishama Jwara etc.
  • Chemical constituents - The bark of the shoots contains milky juice containing caoutchouc. The root and seed contain pregnane glycosides. The stem of the plant contains a glycoside called tenacissoides A-E. Apart from these the plant also contains Marsdenin, D – Cymarose, Asclepobiose, D – Canarose and Cissogen.[15]

2. Bala[16]

Latin name - Sida cordifolia

Family - Malvaceae

Synonyms - Country mallow, Odanika, Bhadra, Samanga, Bariyar, Vatyalika, Kharyashtika, etc.

Rasa - Madhura

Vipaka - Madhura

Veerya - Sheeta

Doshaghnata - Vata Pittaghna

Rogaghnata - Bala is useful in Vata and Pitta Vikaras. It is used in Vranashoth, Netraroga, Pakshaghat, Ardita, Grahani, Raktapitta.

Chemical constituents - Asparagin, alkaloids (hypaphorine, ephedrine and vasicine), phytosterols, mucin, gelatin, resin and potassium nitrate. Rutin has been reported.[17]


3. Chitrak[18]

  • Latin name - Plumbago zeylanica
  • Family - Plumbagenaceae
  • Synonyms - Chita, Agni, Agnimali, Aruna, Dahana, Daruna,
  • Rasa - Katu
  • Vipaka - Katu
  • Veerya - Ushna
  • Rogaghnata - Kapha-Vata Janyavikara, Shlipada, Shotha, Nadi Daurbalya, Vatavyadhi, Agnimandya, Ajirna, Udarashoola. It is abortifacient. It vitiates Pitta and reduces oedema, so it is useful in oedema, liver and spleen disorders.

Chemical constituents: Pungent, having yellow and irritant principle called as plumbagin, 91%. It is soluble in alcohol and ether.[19]

Materials and Methods

Place of work - Screening and selection of patients done in Kayachikitsa OPD and IPD.

1. Follow up of each patient was taken on 15th day, 30th day and 45th

2. Observations were carried out as well as noted on each follow up

Selection Criteria

Inclusion Criteria

1. Pandu Vyadhi was diagnosed according to subjective & objective parameters.

2. Age: 18-60 Yrs. Irrespective of gender, religion, socio - economic status, marital status

3. Hb % more than 8 gm% & less than normal i.e., Male - < 13g/dl, Female - < 12g/dl

Exclusion Criteria

1. Endocrine disorders like hypothyroidism, Cushing syndrome, etc.

2. Pregnant and lactating lady.

3. Patient having tuberculosis, known case of HIV, leprosy, any type of Cancer.

4. Patients showing signs and symptoms of internal bleeding, hemorrhoids, menorrhagia or any other bleeding disorder. (Worms, scurvy, puerperal etc.)


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Withdrawal Criteria

1. If patient develops any adverse effect.

2. If not responding to treatment and aggravation of symptoms.

3. Patient refused to continue treatment.

4. In this clinical study no patient developed any adverse effect.

5. Patients’ withdrawal from the study was due to failure to give follow up.

Table 1: Cardinal sign assessment of Pandu Vyadhi

SN Lakshanas Mild+ Moderate++ Severe+++
1. Panduta (Netra, Nakha, Jivha,) Panduta seen at Netra Panduta present at Netra, Nakha. Panduta present at Netra, Nakha, Jivha.
2. Hridspandan Palpitation after moderate exertion Palpitation on mild Exertion Palpitation at rest
3. Akshikoota Shotha Present Present Absent

S.O.P. (Standard Operating Procedure) for Murvadya Choorna Vati

1. Authentication and standardisation of all the drugs was done.

2. Drugs mentioned in the above yoga were cleaned and dried properly.

3. They were powdered using disintegrator and mixed with each other in equal quantity.

4. This powder was shifted to drier for drying; after sufficient drying, granulation process was carried out.

5. Finally, 500 mg tablets were prepared by using Rotary tablet machine for the convenience and proper dosage.

6. Pack of 30 tablets was prepared.

Drug Administration

Murvadya Choorna Vati - Dose 2gm (twice a day)
Route Oral
Kala Vyanodana
Anupana Koshna Jala
Duration 45 Days
Follow up 15th day, 30th day and 45th day



Observations and Results

Effect of treatment on Panduta at Netra

Table 2: The frequency distribution of Panduta at Netra is given below.

Netra Panduta BT AT
Frequency Percentage Frequency Percentage
Grade 0 0 0.0 2 6.7
Grade 1 2 6.7 28 93.3
Grade 2 17 56.7 0 0.0
Grade 3 11 36.7 0 0.0
Total 30 100.0 30 100.0

Table 3: Effect of treatment on Panduta at Nakha.

The frequency distribution of Panduta at Nakha is given below.

Netra Panduta   BT AT
Frequency Percentage Frequency Percentage
Grade 0 0 0.0 7 23.3
Grade 1 4 13.3 23 76.7
Grade 2 16 53.3 0 0.0
Grade 3 10 33.3 0 0.0
Total 30 100.0 30 100.0

Table 4: Effect of treatment on Panduta at Jivha.

The frequency distribution of Panduta at Jivha is given below.

Jivha Panduta   BT AT
Frequency Percentage Frequency Percentage
Grade 0 0 0.0 14 46.7
Grade 1 6 20.0 16 53.3
Grade 2 21 70.0 0 0.0
Grade 3 3 10.0 0 0.0
Total 30 100.0 30 100.0

Table 5: Effect on Hridspandan.

The frequency distribution of Hridspandan along with graph is given below.

Hridspandana   BT AT
Frequency Percentage Frequency Percentage
Grade 0 1 3.3 9 30.0
Grade 1 6 20.0 21 70.0
Grade 2 15 50.0 0 0.0
Grade 3 8 26.7 0 0.0
Total 30 100.0 30 100.0




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Table 6: Effect on Akshikoota Shotha.

The frequency distribution of Akshikoota Shotha along with graph is given below.

Akshikutshotha   BT AT
Frequency Percentage Frequency Percentage
Grade 0 2 6.7 17 56.7
Grade 1 28 93.3 13 43.3
Grade 2 0 0.0 0 0.0
Grade 3 0 0.0 0 0.0
Total 30 100.0 30 100.0

Table 7: Effect on Sr. Iron Level.

The frequency distribution of Sr. Iron along with graph is given below.

Sr. Iron Count Percentage (%)
Increased 19 63.3
No Change 2 6.7
Decreased 9 30

Using paired t test, p-value is less than 0.05. Hence, we concluded that the effect of Murvadya Choorna Vati is significantly effective in Sr. Iron Level. Average Sr. Iron Level value is increased from 33.20 to 42.63 after 45 days of treatment.

Table 8: Effect on Sr. Iron Level

Sr. Iron Level Mean N SD SE t-Value P-Value % Change Result
BT 33.20 30 17.49 3.19 -2.147 0.040 28.4 Sig
AT 42.63 30 24.51 4.48

There is significant statistical difference in Sr. Iron Level before and after treatment in experimental group. Sr. Iron Level has significantly increased after 45 days of treatment.

Table 9: Effect on Hb%

The frequency distribution of Hb% along with graph is given below.

Hb% Count Percentage (%)
Increased 21 70
No change 9 30
Decreased 0 0

Haemoglobin count calculated in all patients is reported as following -

When it is represented graphically, it is clear, that, Hb% has significantly increased in 70% of patients, decreased in 30% of patients, while it remains unchanged in 0% patients.

Using paired t test, p-value is greater than 0.05.

Hence, we concluded that the effect of Murvadya Choorna Vati is non-significant in RBC Count. Average RBC Count value is increased from 4.47 to 4.64 after 45 days of treatment.

Table 10: Effect on RBC count

RBC count Mean N SD SE t-Value P-Value % Change Result
BT 4.47 29 0.38 0.07 -1.884 0.070 3.9 NS
AT 4.64 29 0.49 0.09

There is no significant statistical difference in RBC Count before and after treatment in experimental group. RBC Count has not significantly increased after 45 days of treatment.

Discussion

Iron deficiency is one of the most important types of anaemia. On an average, globally, 50% of the anaemia is credited to Iron deficiency. In developing countries like India 30% to 70% of the population is iron deficient. Dietary insufficiency, hookworm infestation and lack of food fortification leads to wide prevalence of iron deficiency anaemia in infants, children and women.[20]

The world’s population is increasing at a rapid rate, with the result most of the people are living in un-hygienic, under-nourishing conditions and facing various effects of stress and strain factor. Iron deficiency anaemia is a burning issue globally. In the modern science, there is good treatment for acute Anemia with considerable result but no significant therapy is there for chronic Anemias which occurs due to metabolic defects. Ayurveda can provide better management of this disease. Hence, “An open label single arm study to evaluate the efficacy of Murvadya Choorna Vati in Pandu Vyadhi with special reference to Iron Deficiency Anaemia” was selected.

Total 30 patients were selected for the clinical trials. They were treated with Murvadya Choorna Vati 1gm B.D. with Koshna Jala. The patients were evaluated for 45 days. Their symptoms, clinical presentation and laboratory findings were observed and recorded before and after the treatment. These findings were assessed on the basis of scores which were given before and after treatment of 45 days.

In this study, 33% of patients are reported in Vegodharan, 27% of patients reported Atishrama, 20% patients reported both Atishrama and Vegodharan, while remaining 20% patients


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reported both Atishrama and Atapseva. All these Viharatmak hetus are equally responsible for Pandu Vyadhi.

Out of 30 patients, 6 patients had complained of Asamyak Malapravrutti before starting treatment. During treatment, this symptom was relieved in all the 6 patients. This is an additional observation noted during study. But as effect on Malapravrutti wasn’t the subjective or objective criteria of this study, it wasn’t further evaluated.

Effect on Hb%: As P-value is measured for each criterion, it is evident that –

There is statistically significant increase in Hb%. Among the 30 patients included in the study, 21 patients i.e., 70% have increased Hb% while remaining 9 patients i.e., 30% have decreased Hb% after 45 days of treatment. Statistically it is proved that Murvadya Choorna Vati is significantly effective in Hb%. Besides these statistical values, clinical improvement has been seen in each of the patients. The quality of life has certainly improved after the use of Murvadya Choorna Vati for 45 days.

Sr. Iron Levels: Among the 30 patients, 19 patients i.e., 63.3% showed increase in Sr. Iron Levels, 9 patients i.e., 30% showed decrease while remaining 2 patients i.e., 6.7% showed no change in its value.

From the above findings, we concluded that there is statically significant effect of Murvadya Choorna Vati on Sr. Iron Levels after 45 days of treatment.

As the drug doesn’t have any content which directly increase the Sr. Iron level, it could be helping in increasing the absorption of iron from the diet in the body.

Probable Mode of Action of Murvadya Choorna Vati

Murva being Tikta Rasatmaka, Ushna Veerya and Katu Vipaka, it works as Agnideepana which leads to Aampachana. Also, Tikta Rasa causes Dhatvagni Deepana which helps in healthy Rasa Dhatu formation. Healthy Rasa Dhatu and Dhatvagni Deepana eventually leads to better Dhatu Poshana and healthy Uttarottar Dhatus Nirmiti. This, helps in healthy Oja Dhatu formation. As Oja is the Saar of all Dhatus, it controls the functions of all Dhatus and maintains their performance.[21]

Murva has Sarak property. This Guna of Murva helps

in relieving Asamyak Malpravrutti and carrying out Malanulomana Karma. Also, this Sarak Guna helps in removal of Dushit Pitta from the body thus, causing Deepana and Pachana which in turn increases the absorption of Ahara rasa in the body. Thus, it might be helpful in increasing the absorption of iron in the body.

Murva being Kashaya Rasatmaka, Ushna Veerya and Ruksha Guna causes Kleda Nashan. This helps in removing the Avrodha of the Strotasas, thereby helping in relieving from Dhatu Shaithilya. Thus, leading to Uttam Dhatu Poshana and healthy Dhatus formation. Kashaya Rasa of Murva also helps in mitigating Pitta Dosha and is Rakta Dushtihara.[22]

Conclusion

It is concluded that Murvadya Choorna Vati shows significant results in reducing the symptoms of Pandu Vyadhi. Finally, it is concluded that there is statically significant effect of Murvadya Choorna Vati on Sr. Iron Levels Haemoglobin.

Reference

1. https://www.ncbi.nim.nih.gov/pmc/articles/PMC6691421/ Assess date: 14 March 2023, 12.45PM

2. API, 9th Edition, Editor in chief YP Munjal, Jaypee brothers, Section 15, Chapter No. 4, pp. 928

3. Essential of Medical Pharmacology, by K D Tripathi, 8th edition, section 10, chapter 44, Jaypee brothers medical publishers, New Delhi.657.

4. https://www.healthline.com/health/iron-deficiency-inadequate-ditary-iron Assess date: 14 March 2023, 12.55PM

5. Charaka Samhita, Sutrasthan 32, Choukhamba Orientalia, Varanasi, Reprint edition 2011, Volume I, Shloka No. 5, pp. 327

6. Guidelines for control of IDA, Adolescent division ministry of health and family welfare, Govt. of India, pp. 16.

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8. Guidelines for control of IDA, Adolescent division ministry of health and family welfare, govt. of India, pp. 17.


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9. API, 9TH Edition, Editor in chief YP Munjal, Jaypee brothers, Section 15, Chapter no 4, pp. 929.

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12. Charaka Samhita, Chikitsasthan 32, Choukhamba Orientalia, Varanasi, Reprint edition 2011, Volume I, Adhyaya No.16, Shloka No. 4-6 pp. 422.

13. Gadnigrah, Panduroga Adhyaya, Tripathi I. Kayachikitsa Khand: Pandey G., Editor, Gadnigrah Choukhamba Sanskrit Sanshthan 2, Varanasi, pp. 279.

14. Bhavprakash Samhita of Shri Bhavmishra by Bramhashankar Mishra and Rupalalji Vaishya, First Part, Guduchyadi Varga, Choukhamba Sanskrit Bhavan, Edition 2012, Varanasi, pp. 435.

15. Dravyaguna Vigyan, Part II, By Acharya Priyavat Sharma, Choukhamba Bharati Academy, Varanasi, Reprint 2006, pp. 699.

16. Bhavprakash Samhita of Shri Bhavmishra by Bramhashankar Mishra and Rupalalji Vaishya, First Part, Guduchyadi Varga, Choukhamba Sanskrit Bhavan, Edition 2012, Varanasi, pp. 367.

17. Bhavprakash Samhita of Shri Bhavmishra by Bramhashankar Mishra and Rupalalji Vaishya, First Part, Guduchyadi Varga, Choukhamba Sanskrit Bhavan, Edition 2012, Varanasi, pp. 268.

18. Bhavprakash Samhita of Shri Bhavmishra by Bramhashankar Mishra and Rupalalji Vaishya, First Part, Haritakyadi Varga, Choukhamba Sanskrit Bhavan, Edition 2012, Varanasi, pp. 22.

19. Bhavprakash Samhita of Shri Bhavmishra by Bramhashankar Mishra and Rupalalji Vaishya, First Part, Haritakyadi Varga, Choukhamba Sanskrit Bhavan, Edition 2012, Varanasi, pp. 435.

20. API, 9th Edition, Editor in chief YP Munjal, Jaypee brothers, Section 15, Chapter no 4, pp. 928.

21. Ashtang Sangraha by Dr Bramhanand Tripathi, Choukhamba Sanskrit Pratishtan, Delhi, Reprint 2012, Sutrasthan, Chapter 11, shlok 37-39, pp. 167.

22. Bhavprakash Samhita of Shri Bhavmishra by Bramhashankar Mishra and Rupalalji Vaishya, First Part, Guduchyadi Varga, Choukhamba Sanskrit Bhavan, Edition 2012, Varanasi, pp. 435.


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