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Chapter 8 – Pandu Roga, Kamala, Kumbha kamala, Halimaka Nidanam

The eighth chapter of Madhava Nidana deals with Pandu Roga, Kamala, Kumbha kamala, Halimaka Nidanam which can be co related to Anaemia, Jaundice, Chlorosis etc.,

पाण्डुरोगाः स्मृताः पञ्च वात – पित्त – कफैस्त्रयः |
चतुर्थः सन्निपातेन पञ्चमो भक्षणान्मृदः || १ ||

pāṇḍurōgāḥ smr̥tāḥ pañca vāta – pitta – kaphaistrayaḥ |
caturthaḥ sannipātēna pañcamō bhakṣaṇānmr̥daḥ || 1 ||

Anaemic disorders have been described to be of five types:

  • three due to Vata, Pitta, and Kapha,
  • a fourth one due to the combined vitiation (of all three humors) and
  • the fifth produced due to eating soil.

Etiology of Pandu (Anaemia) –

व्यव्याममम्लं लवणानि मध्यं मृदं दिवास्वप्नमतीव तीक्ष्णम् |
निषेवमाणस्य प्रदूष्य रक्तं दोषास्त्वचं पाण्डुरतां नयन्ति || २ ||

vyavyāmamamlaṁ lavaṇāni madhyaṁ mr̥daṁ divāsvapnamatīva tīkṣṇam |
niṣēvamāṇasya pradūṣya raktaṁ dōṣāstvacaṁ pāṇḍuratāṁ nayanti || 2 ||

One who regularly indulges in strenuous exercise, habitually takes sour and salty foods, alcohol, soil and fast food and sleeps during the day hours will have one’s blood vitiated by doshas. This situation, in turn, generates whitish yellow discolouration of the skin. 2

Premonitary Symptom of Pandu –

त्वक्स्फोटन – ष्टीवन — गात्रसाद – मृद्भक्षण – प्रेक्षणकूटशोथाः |
विण्मूत्रपीतत्वमथाविपाको भविष्यतस्तस्य पुरः साराणि || ३ ||

tvaksphōṭana – ṣṭīvana — gātrasāda – mr̥dbhakṣaṇa – prēkṣaṇakūṭaśōthāḥ |
viṇmūtrapītatvamathāvipākō bhaviṣyatastasya puraḥ sārāṇi || 3 ||

The premonitory symptoms of this disease include –

  • Cracking of the skin,
  • Expectoration
  • Debility
  • Desire of eating mud
  • Oedema of the eye sockets (around the eyes)
  • Yellow discolouration of urine and Faeces
  • Indigestion

Signs and symptoms of Vata Type of Anaemia –

त्वङ्गमूत्र – नयनादीनां रुक्ष – कृष्णारुणाभताः |
वातपाण्ड्वामये तोद – कम्पानाह – भ्रमादयः || ४ ||

tvaṅgamūtra – nayanādīnāṁ rukṣa – kr̥ṣṇāruṇābhatāḥ |
vātapāṇḍvāmayē tōda – kampānāha – bhramādayaḥ || 4 ||

Dryness and blackish or reddish discolouration of the skin, urine and eyes, etc., occur in vataja anemia along pricking sensation, tremors, and constipation with flatulence, giddiness and the like. 4

Signs and symptoms of Pitta Type of Anaemia –

पीतमूत्र – शक्रुन्नेत्रो दाह – तृष्णा – ज्वरान्वितः |
भिन्नविट्को अतिपीताभः पित्त पाण्ड्वामयी नरः || ५ ||

pītamūtra – śakrunnētrō dāha – tr̥ṣṇā – jvarānvitaḥ |
bhinnaviṭkō atipītābhaḥ pitta pāṇḍvāmayī naraḥ || 5 ||

The individual affected by the pitta type of pandu would have

  • yellow coloured faeces and eyes,
  • burning sensation,
  • thirst,
  • fever,
  • loose defecation and
  • his body would appear more yellowish. 5

Signs and symptoms of kapha type of Pandu –

कफप्रसेक – श्वयथु – तन्द्रालस्यातिगौरवैः |
पाण्डुरोगी कफाच्छुक्लैस्त्वङ्गमूत्र – नयनाननैः || ६ ||

kaphaprasēka – śvayathu – tandrālasyātigauravaiḥ |
pāṇḍurōgī kaphācchuklaistvaṅgamūtra – nayanānanaiḥ || 6 ||

In kaphaja pandu, the person will have –

  • Kapha Praseka — Watery discharges (from mouth, nose, eyes and the like)
  • Shvayathu — Oedema,
  • Tandra –Drowsiness,
  • Aalasya — lack of enthusiasm,
  • Gaurava — Heaviness in the body, and
  • Shukla tvak mutra — white discolouration of skin, urine, eyes and face. 6

Signs and symptoms of sannipata type of pandu –

ज्वरारोचक — ह्रुल्लास – च्छर्दि – तृष्णा – क्ल्मान्वितः |
पाण्डुरोगी त्रिभिर्दोषैस्त्याज्यः क्षीणो हतेन्द्रियः || ७ ||

jvarārōcaka — hrullāsa – cchardi – tr̥ṣṇā – klmānvitaḥ |
pāṇḍurōgī tribhirdōṣaistyājyaḥ kṣīṇō hatēndriyaḥ || 7 ||

The symptoms of the Pandu resulting from the vitiation of all the three dosha include –

  • Jwara — Fever
  • Arochaka — Loss of appetite
  • Hrullasa — Nausea
  • Chardi — Vomiting
  • Trshna — Thirst
  • Klama — Weakness
  • Ksheena — Emaciation and
  • Hatendriya — Incapacity of the sense organs.

This disease is incurable and the wise should refuse its treatment. 7

The samprapti (pathogenesis) of the pandu caused by eating soil –

मृत्तिकादनशीलस्य कुप्यत्यन्यतमो मलः |
कषाया मारुतं, पित्त मूषरा, मधुरा कफम् || ८ ||
कोपयेन्मृद्रसादींश्च रौक्ष्याद् भुक्तं च रुक्षयेत् |
पूरयत्यविपक्वैव स्रोतांसि निरुणाद्ध्यपि || ९ ||
इन्द्रियाणां बलं हत्वा तेजो वीर्यौजसी तथा |
पाण्डुरोगं करोत्याशु बल – वर्णाग्निनाशनम् || १० ||

mr̥ttikādanaśīlasya kupyatyanyatamō malaḥ |
kaṣāyā mārutaṁ, pitta mūṣarā, madhurā kapham || 8 ||
kōpayēnmr̥drasādīnśca raukṣyād bhuktaṁ ca rukṣayēt |
pūrayatyavipakvaiva srōtānsi niruṇāddhyapi || 9 ||
indriyāṇāṁ balaṁ hatvā tējō vīryaujasī tathā |
pāṇḍurōgaṁ karōtyāśu bala – varṇāgnināśanam || 10 ||

Atleast one of the doshas of the individual who has a habit of eating mud gets aggravated. The intake of astringent mud promotes Vata; the salty mud would provoke pitta while intake of sweet mud generates kapha.

Due to the dry nature of the soil, it also makes the tissues of the body dry. It will not be digested properly and as a result, it would block various channels. This retards the power of the sensory and motor organs and also the bodily lustre, potency and ojas, thereby producing anemia (pandu roga) which in turn destroys strength, colour and digestion of the patient. 8-10

Symptomatology of Pandu caused by eating soil –

शूनाक्षिकूट — गण्ड — भ्रुः शूनपन्नाभिमेहनः |
क्रिमिकोष्टो अतिसार्येत मलं सास्रुक्कफान्वितम् || ११ ||

śūnākṣikūṭa — gaṇḍa — bhruḥ śūnapannābhimēhanaḥ |
krimikōṣṭō atisāryēta malaṁ sāsrukkaphānvitam || 11 ||

Such persons have oedema of the eye sockets; temples, brows, legs, umbilicus and genital organs; parasites develop inside their abdomen and they pass watery faeces mixed with blood and mucus. 11

Prognosis of Pandu (Anemia) –

पाण्डुरोगश्च चिरोत्पन्नः खरीभूतो न सिध्यति |
कालप्रकर्षाच्छुनानां यो वा पीतानि पश्यति || १२ ||
बद्धाल्पविट् सहरितं सकफं यो अतिसार्यते |
दीनः श्वेतातिदिग्धाङ्गश्छर्दि मूर्च्छा तृडर्दितः || १३ ||
स नास्त्यसृक् क्षयाध्याश्च पाण्डुः श्वेतत्वमाप्नुयात् |

pāṇḍurōgaśca cirōtpannaḥ kharībhūtō na sidhyati |
kālaprakarṣācchunānāṁ yō vā pītāni paśyati || 12 ||
baddhālpaviṭ saharitaṁ sakaphaṁ yō atisāryatē |
dīnaḥ śvētātidigdhāṅgaśchardi mūrcchā tr̥ḍarditaḥ || 13 ||
sa nāstyasr̥k kṣayādhyāśca pāṇḍuḥ śvētatvamāpnuyāt |

Such Pandu roga is incurable if the case is taken after a long duration and hence, the disease has hardened the organs. The disease is incurable if the patient has oedema for a long time and if he sees all objects yellow. It is also incurable in those having constipation or diarrhoea with green mucoid faeces, who are very weak and whose body turns white due to loss of blood. 12 -13

पाण्डुदन्त – नखो यस्तु पाण्डुनेत्रश्च यो भवेत् |
पाण्डुसङ्घातदर्शी च पाण्डुरोगी विनश्यति || १४ ||

pāṇḍudanta – nakhō yastu pāṇḍunētraśca yō bhavēt |
pāṇḍusaṅghātadarśī ca pāṇḍurōgī vinaśyati || 14 ||

Persons whose teeth, nails, and eyes have turned yellowish white and who see everything yellowish or white are likely to die of pandu roga. 14

अन्तेषु शूनं परिहीणमध्यं म्लानं तथा अन्तेषु च मध्यशूनं |
गुदे च शेफस्यथ मुष्कयोश्च शूनं प्रताम्यन्तम संज्ञकल्पम् |
विवर्जयेत्पाण्डुकिनं यशो अर्थी तथा अतिसारज्वरपीडितं च || १५ ||

antēṣu śūnaṁ parihīṇamadhyaṁ mlānaṁ tathā antēṣu ca madhyaśūnaṁ |
gudē ca śēphasyatha muṣkayōśca śūnaṁ pratāmyantama sañjñakalpam |
vivarjayētpāṇḍukinaṁ yaśō arthī tathā atisārajvarapīḍitaṁ ca || 15 ||

The patients who are to be refused treatment are –

  • Who have oedema of the extremities
  • Enlargement of the abdomen
  • Or the patient having both of these symptoms
  • Those who have swelling of rectum, penis and scrotum
  • Those who faint often and lose consciousness
  • Those who are having diarrhoea and fever. 15

Kamala (Jaundice) —

पाण्डुरोगी तु यो अत्यर्थं पित्तलानि निषेवते |
तस्य पित्तमसृङ्गमांसं दग्ध्वा रोगाय कल्पते || १६ ||

pāṇḍurōgī tu yō atyarthaṁ pittalāni niṣēvatē |
tasya pittamasr̥ṅgamānsaṁ dagdhvā rōgāya kalpatē || 16 ||

If a patient of Pandu roga indulges in eatables and habits that promote pitta, his blood and muscle tissues are vitiated. In addition, this situation generates the disease known as Kamala. 16

हारिद्रनेत्रः स बृशं हारिद्रत्वङ्ग नखाननः |
रक्त पीत शकृन्मूत्रो भेकवर्णो हतेन्द्रियः || १७ ||
दाहाविपाक – दौर्बल्य – सदनारुचिकर्षितः |
कामला बहुपित्तैषा कोष्टशाखाश्रया मता || १८ ||

hāridranētraḥ sa br̥śaṁ hāridratvaṅga nakhānanaḥ |
rakta pīta śakr̥nmūtrō bhēkavarṇō hatēndriyaḥ || 17 ||
dāhāvipāka – daurbalya – sadanārucikarṣitaḥ |
kāmalā bahupittaiṣā kōṣṭaśākhāśrayā matā || 18 ||

The features of Kamala (Jaundice) –

  • Deep yellow colouration of the eyes, skin, nails and faeces;
  • Yellow faeces and urine
  • Skin colour resembling a frog (greenish, brown, or brownish yellow),
  • Weakness of sense organs,
  • Burning sensation
  • Indigestion
  • Weakness
  • Debility
  • Anorexia

It involves both the kostha (alimentary tract) and also the sakha (rakta blood) and other dhatus (tissues).

Kumbha Kamala (Advanced stage of Jaundice) –

कालन्तरात् खरीभूता कृच्छ्रा स्यात् कुम्भकामला |

kālantarāt kharībhūtā kr̥cchrā syāt kumbhakāmalā |

If left untreated the above situation makes the organs, hard and subsequently turns into a difficult disease called Kumbha Kamala.

Prognosis of Kamala (Jaundice) –

कृष्णा – पीत शकृन्मूत्रो बृशं शूनश्च मानवः || १९ ||
सरक्ताक्षि – मुख – च्छर्दि विणमूत्रो यश्च ताम्यति |
दाहारुचि – तृडानाह – तन्द्रा – मोह – समन्वितः || २० ||
नष्ताग्निसंज्ञः क्षिप्रं हि कामलावान् विपध्यते |

kr̥ṣṇā – pīta śakr̥nmūtrō br̥śaṁ śūnaśca mānavaḥ || 19 ||
saraktākṣi – mukha – cchardi viṇamūtrō yaśca tāmyati |
dāhāruci – tr̥ḍānāha – tandrā – mōha – samanvitaḥ || 20 ||
naṣtāgnisañjñaḥ kṣipraṁ hi kāmalāvān vipadhyatē |

If a patient of jaundice is passing faeces and urine has turned blackish yellow in colour, if he has developed severe oedema, has reddish discolouration of eyes as well as oral cavity or is passing blood red vomit, faeces or urine, is suffering from giddiness, burning sensation, anorexia, thirst, tympanitis, drowsiness, confusion, subnormal temperature and coma, it would mean that the patient has reached a fatal stage. 19 -20

Prognosis of Kumbha Kamala –

च्छर्द्यरोचक – हृल्लास – ज्वर – क्लमनिपीडितः || २१ ||
नश्यति श्वास कासर्तो विड्भेदी कुम्भकामली |

cchardyarōcaka – hr̥llāsa – jvara – klamanipīḍitaḥ || 21 ||
naśyati śvāsa kāsartō viḍbhēdī kumbhakāmalī |

A patient of kumbha kamala would soon die if he has reached a stage when his disease has got combined with such symptoms as

  • Chardi — vomiting,
  • Arochaka — anorexia,
  • Hrllasa — nausea,
  • Jwara — fever,
  • Klama — fatigue,
  • Shvasa — dyspnea,
  • Kasa — cough and
  • Vidbhedi — diarrhoea. 21

Halimaka (The advanced stage of Pandu) –

यदा तु पाण्डोर्वर्णः स्याद्धरितः श्याव – पीतकः || २२ ||
बलोत्साहक्षयस्तन्द्रा मन्दाग्नित्वं मृदुज्वरः |
स्त्रीष्वहर्षो अङ्गमर्दश्च दाहस्तृष्णा अरुचिर्भ्रमः |
हलिमकं तदा तस्य विध्यादनिलपित्ततः || २३ ||

yadā tu pāṇḍōrvarṇaḥ syāddharitaḥ śyāva – pītakaḥ || 22 ||
balōtsāhakṣayastandrā mandāgnitvaṁ mr̥dujvaraḥ |
strīṣvaharṣō aṅgamardaśca dāhastr̥ṣṇā arucirbhramaḥ |
halimakaṁ tadā tasya vidhyādanilapittataḥ || 23 ||

When the individual suffering from Pandu develops yellow, green or blackish yellow colour (of the skin, nails, eyes, urine and the like), and experiences diminishing of strength and enthusiasm, suffers from drowsiness, loss of appetite, mild fever, lack of desire for women, pain all over the body, burning sensation, thirst, anorexia, and giddiness, he should be considered as suffering from halimaka (chlorosis) which is due to vitiated vata and pitta. 22 -23

इति श्रीविजयरक्षितकृतायां मधुकोशव्यख्यायां पाण्डुरोग कामला – कुम्भकामलाहलीमकनिदानं समाप्तम् || ८ ||

iti śrīvijayarakṣitakr̥tāyāṁ madhukōśavyakhyāyāṁ pāṇḍurōga kāmalā – kumbhakāmalāhalīmakanidānaṁ samāptam || 8 ||