E-ISSN:2456-3110

Review Article

Pandu Roga

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

A Literary Review on Pandu Roga

Monika1*, Kumar A2, Milan R3, Kumar J4
DOI:10.21760/jaims.9.7.18

1* Monika, Junior Resident, Department of Roga Nidana Evum Vikriti Vigyana, Government Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

2 Avadhesh Kumar, Professor and HOD, Department of Roga Nidana Evum Vikriti Vigyana, Government Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

3 Ram Milan, Associate Professor, Department of Dravya Guna, Government Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

4 Jitendra Kumar, Assistant Professor, Department of Rachana Sharir, Government Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

In Ayurvedic classics, the description of Pandu is available in three forms i.e., Pandu as a disease, Pandu as a complication, and Pandu as a sign of certain diseases. Pandu Roga is one of the diseases mentioned in Ayurveda characterised by changes in the skin colour to white (Shweta), yellowish (Peeta), greenish (Harita) etc. which is one of the “Varnopalakshita Roga" i.e., a disease characterised by the change in the colour. Pandu is a disease of Rasa-Vaha Srotas and it is a Pitta Pradhan Vyadhi in which due to Pitta Pradhan Hetusevana, Pitta dominant Tri Dosha Prakopa occurs and causes Dhatu Shaithilyam and Dhatu Gauravam, further it leads Sneha, Bala, Varna, and Ojokshaya and due to this Rakta and Meda Dhatu decreases and Vaivarnata occurs. The clinical condition of Pandu in Ayurveda resembles the anaemia described in Modern Medical Science, due to the resemblance in the clinical signs and symptoms. Anaemia is a major global public health problem and the most prevalent nutritional deficiency disorder in the world and has serious consequences for national development. This article discusses anaemia (Pandu) from an Ayurvedic perspective.

Keywords: Pandu, Varnopalakshita Roga, Rasa-Vaha Srotas, Dhatu Shaithilyam, Dhatu Gauravam, Anaemia, nutritional deficiency

Corresponding Author How to Cite this Article To Browse
Monika, Junior Resident, Department of Roga Nidana Evum Vikriti Vigyana, Government Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.
Email: 		Monika, Kumar A, Milan R, Kumar J, A Literary Review on Pandu Roga. J Ayu Int Med Sci. 2024;9(7):131-137.
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https://jaims.in/jaims/article/view/3430

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-12 2024-05-22 2024-10-05 2024-06-12 2024-06-19
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© 2024by Monika, Kumar A, Milan R, Kumar Jand 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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Introduction

Ayurveda, literally translating from Sanskrit to "the science of life," is an ancient Indian system of medicine that emphasizes a holistic approach to health and wellbeing, focusing on preventing illness and promoting balance in the body, mind, and spirit. Pandu Roga is one of the Varnopalakshita Rogas mentioned in Ayurveda characterised by changes in skin colour to white (Shweta), yellowish (Peeta), greenish (Harita), etc. Acharya Charak and Vagbhatta accepted Pandu Roga as a disease of Rasavaha Strotas, while according to Sushruta it is of Raktavaha Srotas. It is described with its pathogenesis and treatment in Ayurvedic texts Bruhattrayi and Laghutrayi.It is often seen that Rakta gets vitiated by Dosha, mainly by Pitta Dosha as Rakta is Pittavargiya and disease like Pandu Roga appear. Pandu Roga is Pitta Pradhana Vyadhi. Due to Hetu Sevana, Pitta Pradhana Tridosha gets vitiated and circulated in the whole body causing Shithilata in all Dhatu which ultimately reduces Rakta and Meda Dhatu. There is Sneha and Rakta Dhatu are decreased and also Rupa, Oja Guna, Varna, Bala are reduced in Pandu Roga.

A prominent diagnostic feature of Pandu Roga is the pallor of the skin which occurs due to the quantitative and qualitative deficiency of Rakta Dhatu. Considering Panduta as the predominant sign, the disease is termed Pandu Roga. Pandu means mixture of white and yellow colour which resembles the pollen grains of the Ketaki flower. 

Aims and Objectives

To review the concept of Pandu Roga from different Ayurvedic literature.

Materials and Methods

Material has been collected from ancient Ayurvedic texts, Research Journals, and electronic databases.

Historical Review

पित्तेन पाण्डुना वापि धुम धम्रारुपेन वा। विशिर्यता महाभ्रेण महता चानुप गुणा ।। (अथर्ववेद परिशिष्ट 58.ख.25)

लोहचुर्ण तकपीतं पाण्डु रोगहरं भवेत् । (इतिगारुड़े)

According to Rigveda and Atharvaveda, Panduroga is known as Vilohit, Haribha, and Halima.

In Garuda Purana, it has been described that Takra mixed with loha churna is useful in Panduroga.

  • Acharya Charak -Pandu Roga has been described in Sutrasthana in Ashtodariya Adhyaya as well as in Chikitsasthana 16th Chapter "Pandu Roga Chikitsa". Acharya Sushruta has said Pandu Roga in Uttartantra Adhyaya 44, "Pandu Adhyaya" Sushruta has mentioned Kamala, Kumbhavhaya, Lagharak as various stages of Pandu.
  • Acharya Vagbhatta has described Pandu in Nidanasthana 13th adhyay Pandu Roga- Shopha Visarpa Nidana and in Chikitsasthana 16th Adhyay, (Pandu Roga Chikitsa). In Madhava Nidana description of Pandu Roga is in 8th Adhyay Pandu Roga.
  • In Sharangdhara Samhita described in Pradhana Khanda 7th Adhyaya.
  • In Bhavprakasha description of Pandu Roga in Madhyam Khanda 8th Adhyaya.
  • In Ashtanga Hridaya has described Pandu in Nidana Sthana Adhyaya.

Review of Literature

Vyutpati

The word “Pandu” is derived from root “Padi Nasane” with suffix “Ku” and elaboration through “Ni”. The meaning is always taken in sense of "Nashana" i.e., loss. (Shabdakalpadruma - Part 3)

Nirukti of Pandu

According to Vachaspatyam (Part 5) 'Pandustu Peet-bhagardhm Ketaki Dhulisannibham’ means Pandu is like colour of pollen grains of Ketaki flower which is whitish-yellow.

‘Pandutwenuplakshito Rogah Pandu Rogah’ means disease which resembles Pandu Varna is known as Pandu.

Definition of Pandu

Sarveshu Chaiteshvih Pandubhavo Yatoadhikoatah Khalu Pandurogah. (Su.Ut. 44/4). It is called Pandu Roga because of predominance of paleness all over body.

Synonyms

According to Shushrut Kamala, Panki, Laghrak, Alas and Kumbhahwa are synonyms of Pandu.


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In Rigveda and Atharvaveda Pandu has been described by name of Vilohita, Halima, and Haribha.

Types of Pandu Roga

Acharya Charak described disease under five categories namely Vataj, Pittaj, Kaphaj, Sannipataj, and Mridabhakshanajanya and Acharya Shushrut has accepted only four types of Pandu excluding Mridabhakshanjanya Pandu, they are:

1. Vataj Pandu
2. Pittaj Pandu
3. Kaphaj Pandu
4. Sanipataj Pandu
5. Mridikabhakshanjaya Pandu

Acharya Harita mentioned eight types of Pandu in Harita Samhita and described Kamla, Kumbhakamla, and Halimaka as their Synonyms.

Nidana (Causative Factors)

क्षाराम्ललवणात्युष्णविरुद्धासात्म्यभोजनात्।

निष्पावमाषपिण्याकतिलतैलनिषेवणात् ।।

विदग्धेऽन्ने दिवास्वप्नाव्यायामान्मैथुनात्तथा ।

प्रतिकर्मतुवैषम्याद्वेगानां च विधारणात् ।।

कामचिन्ताभयक्रोधशोकोपहतचेतसः । Ch.Chi.16/7-9

Nidana of Pandu roga can be classified into following categories:

Aharaja Nidana: Acharya Charaka has described following etiological factors regarding Ahara:

Excessive intake of Kshara, Amla, Lavana, Ati Ushnaanna, Virruddha Bhojana & Asatmya Bhojana.

Excessive intake of Nishpava, Masha, Pinyaka, and

Excessive intake of Madya.

Excessive intake of Kashaya, Katu Rasa.

Viharaj Nidana

Excessive Diwaswapan, Vyayama and Maithun. Pratikarma Vaishmaya (faulty administration of panchakarma) and Ritu Vaishamya (faulty management of seasonal regimen) Suppression of natural urge (Vega Dharan)

Mansik Nidana

Mansik Nidan i.e., anxiety, fear, anger, and grief have a major role in the manifestation of Pandu.

Other / Secondary / Nidanarthaka causes

In Ayurvedic literature, there is an indication of correlation between various diseases & Pandu Roga either as a symptom or as Upadrava. So, all these can be causes of Pandu i.e., Nidanarthaka Roga of Pandu. E.g., Raktatipravartana, Raktaarsha, Raktarbuda, Asrigdara or Raktapradara, Rajyakshama, Punara-Vartaka Jwara, etc. which can directly or indirectly vitiate Vata-Pitta Dosha singly or in combination & manifest as Pandu Roga.

Purvarupa (Prodromal Symptoms)

According to Acharya Charak

Tasya Lingam Bhavishytah Hridyaspandanam Rokshyam Swedabhavah Shramsatatha. (Ch. Chi. 16/12) Hridyaspandanam (Palpitation), Rokshyam (dryness of skin), Swedabhavah (absence of sweating), Shramsatatha (fatigue)

According to Acharya Sushruta:

Twaksphotnam Shthevangatrasadoo Mridbhakshanam Prekshankootsothah. Vidmutrapitatwamathaavipako Bhavishtasya Pu-rahsarani. (Su.U. 44/5) Twaksphotnam (cracking of skin), Shthevan (salivation), Gatrasada (sense of lassitude in limbs), Mridbhakshanam (liking for mud intake), Prekshankootsothhah (swelling over eye socket), Vid-Mutra Pitata (yellow colour of stool-urine), Avi-paka (Indigestion) these are mentioned by Sushruta.

Rupa (Symptoms)

Acharya Charak has mentioned Samanya and Vishesh Rupa of Pandu Roga in chapter 16 of Chikitsa Sthaan according to Dosha involvement which is mentioned below.

दुर्बलः सदनोऽन्नद्विट् श्रमभ्रमनिपीडितः ।। गात्रशूलज्वरश्वासगौरवारुचिमान्नरः । मृदितैरिव गात्रैश्च पीडितोन्मथितैरिव ।। शूनाक्षिकूटो हरितः शीर्णलोमा हतप्रभः । कोपनः शिशिरद्वेषी निद्रालुः ष्टिवनोऽल्पवाक् ।। पिण्डिकोद्वेष्टकटयूरुपादरुक्सदनानि च। भवन्त्यारोहणायासै ……… ।। Ch.Chi.16/13-16

Samanya Rupa

  • Loss of Indriye Bala, Tej, Veerya and Loss of Bala, Varna and Agni (power of digestion).
  • Karnashveda (tinnitus), Daurbalya (general weakness), Annadwesha (aversion towards food), Shrama (fatigue), Bhramanipidita (giddiness), Gatrashula (body ache), Jwara (fever), Shwasa (breathlessness), Gaurva (heaviness), Aruchi (anorexia).

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  • Akshikutashoth (swelling over orbit), Shirnaloma (hair fall), Hataprabha (loss of body complexion/lustre)
  • Kopana (dislikes cold things), Nidralu (feeling of drowsiness), Alpawaka (avoid speaking), Shtheevan (spitting frequently)
  • Pindikodweshthana (calf muscle pain), Katiuru-Paad Ruka (pain in the lumbar, thighs and feet), Arohaneayasa (patient feels exhausted on climbing)

Vishishta Rupa: Acharya Charka had classified Pandu Roga into 5 types; based on these types Vishesh Rupas are described-

Vataj Pandu: Krishna-Panduta (black and pale-yellow discolouration), Rukshata (roughness), Aruna-Angatam (Reddishness of the body), Angmarda (body ache), Ruja (pain), Toda (Pricking type of pain), Kampa (tremor), Parshvashiro-Ruja (pain in chest-head), Varchashosh (dryness of stool), Aashyavairasya (distaste in mouth), Shopha (oedema over body parts), Aanah (constipation), Bala-Kshaya (weakness).

Pittaja Pandu: Pita-Haritabhata (complexion become either yellow or green), Jwara, Daha (burning sensation), Trishna (excessive thirst), Murcha (fainting), Pipasa, Pitamutrashakruta (yellowish discolouration of urine and stool), Sweda (profuse sweating), Sheetakamta (increase desire to take cold things), Katukasayta (feeling pungent taste in mouth), Ushnaamlanupashyata (uneasiness for hot and sour things), Vidahe Vidagadhe Anne (feeling of burning sensation during indigestion of food), Daurgandhya (foul smell of body), Daurbalya (weakness), Bhinn-Varcha (diarrhoea).

Kaphaja Pandu: Gaurava (heaviness), Tandra (Drowsiness), Chhardi, Shvetavbhasta (whitish complexion), Praseka (excessive salivation), Lomoharsha (Horripilation), Murchha (Fainting), Bhrama (giddiness), Klama (mental fatigue), Sa-da (looseness of body parts), Kasa, Shwasa (dyspnoea), Alasya (laziness), Aruchi (anorexia), Vaka-swaragraha (obstruction of speech and voice), Shukla Mutra-Akshivarchasa (whitish discolouration of urine, eye and stool), Katurukshoshna Kamta (feeling to take pungent, Hot and dry things), Shwayathu, Madhurasyata (sweetishness in mouth).

Sannipataj Pandu: Signs & symptoms of all three vitiated Doshas are present, and this is extremely intolerable because of developing complications.

Mridbhakshanajanya Pandu: Bala-Varna-Agni Nash (loss of strength, complexion, and power of digestion metabolism), Ganda-Akshikuta-Bhru-Pad-Nabhi-Mehan Shotha (oedema on cheek, eye socket, eyebrow, feet, umbilical region, genital parts), Krimi Koshta (Appearance of intestinal worm), Atisaryet Mala Sasruka Kapha (diarrhoea associated with blood and mucus).

Samprapti (Pathogenesis)

समवस्थितम्।। वायुना बलिना क्षिप्तं संप्राप्य धमनीर्दश। प्रपन्न केवलं देहं त्वड्मांसान्तरमाश्रितम् ।।

प्रदूष्य कफवातासृक् त्वमांसानि करोति तत् । पाण्डुहारिद्रहरितान् वर्णान् बहुविधांस्त्वचि ।। Ch.Chi.16/9-11

Acharya Charaka has mentioned the Samprapti of Pandu in Chikitsa Sthan. According to him, due to consumption of Nidana Pitta located in the Hridaya (Sadhak Pitta) gets aggravated and is expelled from Hridya by powerful Vata and it enters the Dash-Dhamanya (attached to the heart) and circulates all over the body. This aggravated Pitta reaches the space between skin and muscle tissue, bringing vitiation in Kapha, Vata, Asrika, Twaka and Mamsa. This leads to abnormal types of colouration like Pandu, Haridra and Harita on the skin.

Samprapti Ghataka

  • Dosha - Pitta Pradhan Tridoshaja
    • Pitta - Sadhaka, Ranjaka and Bhrajaka
    • Kapha - Avalambaka, Kledaka
    • Vyana - Vyan Vayu, Samana Vayu
  • Dushya - Twaka, Rasa, Rakta, Mamsa and
  • Strotas - Rasavaha, Raktavaha
  • Stroto Dushti - Sanga and Vimarga Gamanam.
  • Agni - Jatharagni and
  • Agni Dushti - Mandagni
  • Udbhavasthaan - Amashaya
  • Adhishthana - Twaka Mamsa Abhyantara
  • Vyaktasthaan - Twaka
  • Sancharasthaan - Twaka & Mamsa
  • Svabhav - Chirkari

Sadhya-Asadhyata

Patients of persistent chronic Pandu Roga whose Dhatu gets Khar are not cured.


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Also develops oedema observes all the objects yellowish in colour. Sharir Dhatus becomes Ruksha and a decrease in Bala and Varna occurs and Shotha develops. Rogi suffers from constipation and passes loose stools with mucus having greenish discolouration and becomes Deena, who suffers from Murcha and Trushna.

Chikitsa

According to Acharya Charak

तत्र पाण्ड्वामयी स्निग्धस्तीक्ष्णैरुध्वानुलोमिकैः । संशोध्यो मृदुभिस्तिक्तैः कामली तु विरेचनैः ।।

ताभ्यां संशुद्धकोष्ठाभ्यां पथ्यान्यान्नानि दापयेत् । Ch.Chi.16/40-41

According to Acharya Charak in Sadhya Pandu Rog, Teekshna Vaman and Virechan should be done.

Upadrava

According to Acharya Sushruta Aruchi, Pipasa, Vaman, Jwara, Murdharuja, Agnisada Shopha, Kanthagata Abalatwa, Murcchha, Klama and Hrudayapidana are the Updrava of Pandu Roga.

Pathya-Apathya

  • Pathyahara

According to Acharya Charak

  • Shalianna, Yava, and Godhoom mixed with Yusha prepared from Mudga, Adhaki and Masur
  • Jangal Mamsa Rasa
  • Panchagavya Ghrit, Mahatiktaka Ghrit and Kalyanaka Ghrit used for Snehan Karma.

According to Acharya Susruta

  • Pandu Rogi must use Arishta prepared from Guda, Sharkara (sugar) and Shahad (honey)
  • Asava prepared from Mutra and Kshara should be used
  • Jangala Mamsa Rasa added with Sneha (fat) and Amalaka Swaras should be used
  • Apathyahara

In Bhaisajya Ratnavali following Apathya Aahar are mentioned:

  • Rakta Sruti, Dhoompan, Vaman Vega Dharan, Swedan and Maithoon are to be avoided by Pan-Du Rogi.
  • Avoid consumption of Shimbi, Patrashaak, Ra-Math, Masha, Ambupaan, Pindyaak, Tambul, Sarshapa, and
  • Intake of water from rivers like those originating from Vindhya and Sahyadri
  • All types of salt, sour edibles, Virudhha Anna (incompatible foods), food that is Guru (heavy to digest) and Vidahi (cause a burning sensation).

Discussion and Conclusion

Pandu Roga, primarily a Pitta-dominant disorder, involves vitiation of Pitta which normally governs the body's natural color; its imbalance leads to pallor or Panduta. However, alongside Pitta, Vata Dosha, particularly Vyana Vayu, also contributes significantly to the onset of Pandu Roga. This condition affects many and is classified in ancient texts into five types: Vatika, Paittika, Kaphaja, Tridoshaja, and Mridabhakshhanajanya Pandu, all affecting the Rasvaha Srotas. Several factors contribute to Pandu Roga, such as irregular daily routines, both mental and physical, as well as poor dietary habits including insufficient and poor-quality food (Mridikabhakshana). According to Charaka, three warning signs precede its onset: Hridyaspandanam (palpitation), Rokshyam (dryness), and Shram (fatigue). Acharya Sushruta has classified Panduroga into four types, while Acharya Charaka has added an additional type known as Mrida Bhakshanjanya Pandu. Acharya Vagbhatta has also elaborated on the pathogenesis described by Acharya Charaka, emphasizing that Pandu Bhava arises from vitiation of Twaka due to the impurity of Rakta in individuals engaging in harmful dietary and lifestyle practices. The pathology of Panduroga primarily involves vitiation of Pitta, which subsequently affects Rakta, leading to manifestation of Pandu Bhava. Pitta's role in disorder impacts all five of its primary functions, with particular emphasis on Ranjana (colouring) and Bhrajan (digestion). This disturbance in Pitta leads to loosening and heaviness of Dhatus, causing depletion (Balakshaya), loss of complexion (Varnakshaya), and reduced vitality (Ojakshaya). Eventually, Panduroga presents with symptoms such as paleness (Raktalpata), weakness (Medalpata), dryness (Nihsarata), discolouration (Vivarnata), and loss of sensory functions (Shithilendriyata).Santarpana, which refers broadly to anabolic processes, exacerbates production of Kapha and Ama, leading to sluggish digestion (Mandagni) and changes in complexion, namely pallor (Panduta).


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The vitiation of Kapha is responsible for heaviness (Gaurava), excessive sleepiness (Nidraluta), lethargy (Alasya), and reduced appetite (Alpavaka). Symptoms such as loss of appetite (Aruchi), fever (Jwara), pallor (Panduta), heaviness (Gaurava), and drowsiness (Tandra) indicate a disturbance in the Rasa Dhatu.

Body ache (Angamarda) suggests the involvement of both Rasa and Rakta Dhatus, while emaciation (Karshya) indicates impairment of the Mamsa Dhatu. Excessive sweating (Atisveda) and absence of sweating (Svedabhava) suggest the involvement of Twak (skin), Mamsa (muscle), and Meda (fat) Dhatus. Thinning and alopecia (Shirnalomata) are significant indicators of Asthi Dhatu disturbance, while loss of lustre and debility suggest depletion of Oja. The Samhitas detail the general and specific characteristics of Pandu Roga.

While treatable, Pandu Roga can lead to complications if chronic, underscoring the importance of early intervention. Charaka advises aggressive therapies like Teekshna Vaman (therapeutic emesis) and Virechan (purgation) in their early stages. To effectively diagnose and treat Pandu Roga, a physician must possess comprehensive knowledge of various Samhitas, ensuring accurate treatment. The clinical presentation of Pandu can be correlated with anemia in modern medical terms, characterized by pallor due to blood deficiency, although it remains one of the most underdiagnosed conditions.

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