Introduction

Ayurveda is one of the most renowned traditional systems of medicine that has survived and flourished from ages till date. There are many avenues still to be explored by the researchers, practitioners and experts in the field who carry the responsibility of keeping the traditional systems of medicine alive and contributing to their growth in the future. In Ayurveda, Pandu Roga is considered as a specific disease with detailed Nidana, Purvarupa, Rupa, Samprapati and Chikitsa. An effort has been made to understand the Pandu Roga according to Ayurvedic classics. Pandu is characterized by Pandu Varnya^[1] of body with other Lakshanas like Agnimandya, Daurbalya, Angamarda etc. and can be correlated to Anemia in contemporary medicine. In Greek the word Anaemia means a lack of blood. More correctly, it is the deficiency of haemoglobin and there are several grades for this deficiency. Anaemia can result from a number of reasons, like nutritional deficiencies, acute or chronic blood loss due to trauma or diseases, destruction of red blood cells by various metabolic and immunological abnormalities or toxins, disease of the bone marrow, general systemic diseases like infections and varieties of cancers and kidney failure.^[2]

Anaemia affects all age groups. However, most susceptible groups are pregnant women and young children. In milder form, Anaemia is “silent” & deprived of symptoms. Without treatment, Anaemia can worsen & become an underlying cause of chronic ill-health, such as impaired fetal development during pregnancy, delayed cognitive development & increased risk of infection in young children & reduced physical capacity in all people. If haemoglobin level is very low (less than 6 gm) Anemia needs to be corrected on an urgent basis. There is no doubt that preventive measures in the form of proper dietary supplements & malabsorption preventions are primarily preferred choice of treatment. The disease causes mild, moderate or even severe degree of morbidity & rarely mortality. Brahmi (Bacopa monnieri (Linn.) Pennell.) is an important drug of Ayurveda classical texts & Indian Materia medica. Brahmi forms an ingredient in many Ayurvedic formulations viz., Brahmi Rasayana, Brahmi Ghrita, Brahmi Taila, Brahmi Vati & Sarasvatarishta & has been recommended as medication for treatment of anaemia,

Vyadhi Vrittantam (H/O Present Illness):

A 26-year-old lady patient presented at the OPD of Dravyaguna Department, Govt. Ayurvedic Hospital Erragadda, with general weakness, pain all over the body and giddiness for 1 year. She took some other medications but did not get relieved.

Purva Vrittantam (H/O Past Illness):

No relevant past history mentioned.

Not a known case of HTN, T2DM

Past Surgical History

No such relevant past surgical history found.

Parivarika Vrittantam (Family History):

No family members are there with the same complaints.

General Examination

Temperature - 98.5° F
Blood Pressure - 110/80 mmHg
Respiratory Rate - 20 per minute
Pulse Rate - 78 per minute
Pallor - Present
Cyanosis - Absent
Tongue - Coated
Icterus - Absent
Oedema - Absent

Systemic Examination

Respiratory System

Bilaterally symmetrical, no deformities or scars seen. Chest expansion is normal.

No abnormal sound detected.

Cardiovascular System

S1 and s2 heard normally. No added sounds heard

Gastrointestinal System

No organomegaly detected, Umbilicus placed centrally, Shape is scaphoid, Bowel sounds are regular

Central Nervous System

Patient is well conscious Orientation is well with the time, person and place Reflexes are normal

Ashtasthana Pariksha

Naadi - Vatapittaja

resulting in Alparaktata, Alpamedhaskata, Nissaratha, Shithilendriyatha and Vaivarnya etc. Lakshana Yukta Vyadhi called as Pandu Roga. Patient had been complaining of general weakness, pain all over the body and giddiness for past one year. Palpitation, Pallor in face, nails and sclera of eyes, exertion on doing heavy work, and reduced appetite and digestion were also present. After using Brahmi Panchanga Churna, 5g twice daily, for 120 days, the clinical outcomes recorded are notable. Hb% changed from 9g/dL to 11g/dL. Duration was taken as 120 days as average lifespan of a red blood cell in humans is around 120 days.

Rasapanchaka of Brahmi

There are different opinions about doshaghnatwa of Brahmi. According to Dhanwantari Nighantu^[4] and API it is Vata Kaphahara. Madhava Dravyaguna says it as Tridoshaghna. It is rich in various micronutrients and micronutrients that contribute to its potential health benefits. Macronutrients include carbohydrate, protein containing all essential amino acids, and fats. Micronutrients in Brahmi includes Vit.A, Vit.C, Vit.E, Vit.K and minerals like Calcium, Iron, Magnesium, Potassium and Zinc.

Mode of Action

In Dourbalya [General weakness]: In Pandu, Agni is in Mandavastha that leads to formation of Ama and improper development of Rasa and Rakta which in turn causes Uttarothara Dhatukshaya.^[5,6] This leads to decrease in Ojas and Bala, and thus Dourbalya is seen as a symptom in Pandu Roga. Brahmi possess Tikta Kashaya Madhura Rasa, Laghu Guna, Dipana and Amaghna Karma. Tikta Rasa is Agnidipana, with Pachana properties. Amapachana property facilitates proper Rasadhatu Pushti followed by Uttarottara Dhatu Vrudhi. Dourbalya is associated with Vata Kopa and Brahmi is also Vatahara. This drug possesses Madhura Rasavipaka. Madhura Rasa is Sarvadhatuvivardhana and Ksheenahita according to Vagbhata. It is Balya, Brumhana, Jeevana and Tarpana also, so it nourishes the body and provides strength, helping to alleviate weakness associated with anemia. Brahmi also contains phenols, flavonoids,

promoting better digestive health. Tikta Kashaya Rasa stimulates appetite and digestion and helps in detoxification which can improve overall health.

In Bhrama [Giddiness]: Brahmi possess Tikta Kashaya Rasa which stimulates digestion and appetite, Dipana Karma and Amahara Karma. Sita Virya helps to cool the body and reduces inflammation which is effective in reducing dizziness. It improves the nerve function, reduces the stress and alleviate Bhrama. Brahmi can help the improvement of circulation thus providing adequate oxygen and nutrients to organs and this leads to reduced dizziness. Bhrama is a Vata Pradhana Lakshana and can be alleviated due to the Vatahara property of Brahmi. Anemia can cause electrolyte imbalance, particularly of potassium, calcium and magnesium levels, which may lead to bhrama. Brahmi is a good source for these micronutrients as well. Its overall calming and stress-reducing effects might indirectly help alleviate symptoms of dizziness.^[10]

In Pandutwa [Pallor]: Pale skin or pallor is a main symptom in anemia. Madhura Rasa is good for Varna and Indriya, and Kashaya Rasa has Twak Savarnakrut property, according to Vagbhata. Tikta Rasa due to Dipana and Pachana Karmas stimulates digestion and appetite and Madhura helps in detoxification (Vishahara) which can improve overall skin health and reduce pallor. As Madhura rasa is Sarvadhathuvivardhana it will increase Rakth Dhatu which in turn reduce pallor. Sita Virya helps to cool the body and reduce inflammation, which can be beneficial for conditions like pallor.

In Hata Anala [Reduced digestive power]: In Hata Anala digestion is reduced or delayed. Here Dipana and Pachana Karma of Tikta Rasa, kledahara and Lekhana Karma of Kashaya Rasa is effective for reducing the symptoms. Kashaya Rasa will absorb excess Kleda and toxins from the body and provide better digestion. Tikta Rasa stimulates appetite and helps in detoxification, which can improve overall gut health and digestion. The anti-inflammatory, hepatoprotective and anti-oxidant property of Brahmi might have a positive impact on digestion.^[11]

Effect on improvement of Hb%: In anemia, the Hb% will be lower than the normal range. This may be because of deficiency in micronutrients like iron, Vitamin B₁₂, Vitamin B₉ etc., which are present in Brahmi.