the effect of mandura vataka and nishamalaki in …

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912

Bhuvaneswari et al. World Journal of Pharmaceutical Research

THE EFFECT OF MANDURA VATAKA AND NISHAMALAKI IN

PANDU ROGA - A RANDOMIZED CLINICAL TRIAL

Dr. C. Bhuvaneswari*1, Dr. K. Venkat Shivudu

2 and Dr. G. Lavanya

3

1P.G.Final year, Department of Ayurveda Samhita & Siddhanta, S.V.Ayurvedic College,

Tirupathi.

2Assistant Professor, Ayurveda Samhita & Siddhanta, S.V.Ayurvedic College, Tirupathi.

3Associate Professor, Dept. of. Swasthavrutta, S.V.Ayurvedic College, Tirupathi.

ABSTRACT

In Ayurveda, Pandu is considered as a specific disease with its own

pathogenesis and treatment. Pandu is a disease characterized by pallor

of body which strikingly resembles with ‘Anaemia’ of modern science,

due to reduction in number of RBCs per cumm of Blood and quantity

of Hb resulting in pallor. For the present study total 40 patients of

Pandu roga have been randomly selected, divided in to 2 groups, 20

patients in each Group. Group A treated with Manduravataka (250 mg

each) twice daily with Madhu for 45-60 days. Group B treated with

Nishamalaki (500mg each) twice daily with Luke warm water for 45-

60 days. Results were analyzed by using the paired t-test for subjective

and objective parameters for both groups. The results between the two groups were analyzed

by using the unpaired t-test. While comparing the results the Group A showed better results

than Group B.

KEYWORDS: Ayurveda, Pandu, Manduravataka, Nishamlaki etc.

INTRODUCTION

Anaemia is one of the most prevalent Nutritional disorders all over the world particularly in

the developing countries like India. It effects all age groups irrespective of gender, cast, creed

and religion, but most prevalent in children, pregnant women and non pregnant women of

child bearing age. According to the report of national family health survey [NFHS]

adolescence and anaemia are going hand in hand where 56% of adolescent girls and 30%

Adolescent boys suffer from anaemia. Globally1.62 billion people are affected by anaemia.

World Journal of Pharmaceutical Research SJIF Impact Factor 6.805

Volume 5, Issue 11, 912-924. Research Article ISSN 2277– 7105

*Corresponding Author

Dr. C. Bhuvaneswari

P.G.Final year, Department

of Ayurveda Samhita &

Siddhanta, S.V.Ayurvedic

College, Tirupathi.

Article Received on

26 August 2016,

Revised on 15 Sept. 2016,

Accepted on 05 Oct. 2016

DOI: 10.20959/wjpr201611-7223


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The present human health conditions around the globe are far from satisfaction. The day-to-

day advancement in each and every aspect of living has made the life very fast, hectic and

full of stress. In such an outfit, in order to adjust themselves every person is compelled to

make life fast and mechanical. This is the reason why people have no time for themselves,

even shifting from basic home cooked to pre cooked and fast food having very less

nutritional value.

CLINICAL PLAN

Phase 1: patients will be selected from O.P.D. and I.P.D. P.G Dept. of Ayurveda Samhita and

Sidhanta, S.V.Ayurvedic College and Hospital, Tirupati

Inclusion criteria

1. Patients with Hb% in the range of below 11 gms.

2. Patients of both sexes are equally considered for the study.

3. Persons aging between 16-60 years.

Exclusion criteria

1. Patients with history of hypertension, diabetes.

2. Patients with history of congenital haemopoetic disorders, eg- haemophilia, leukaemia.

3. Patients suffering from infectious disease malaria, haemophilia, G.I.bleeding, fever, piles

etc.

Clinical parameters

Subjective:

Pandhuta [1]

Arohana ayasah [2]

Dourbalya

Twakspotana [3]

Karnakshweda [4]

Objective

Hb%

TC

DC

ESR


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Whenever necessary- Urine examination and stool examination.

Phase 2: All the patients selected for the study have been categorized into two groups. One

group was given Manduravataka and second group were given Nishamalaki.

Phase 3: Clinical data of patients has been collected, analyzed and interpreted.

MATERIAL AND METHODS

Materials – Group - A

Guda - 1 part

Nagara - 1 part

Mandura - 1 part

Tila - 1 part

Pippali - 2 part[5]

Group A : In this group 20 patients were selected.

Dose : 250 mg twice daily

Anupana : Madhu

Duration : 45-60 days

Materials Group – B

Nisha (Haridra) and Amalaki.

Group B : In this group, 20 patients were selected.

Dose : 500mg twice daily

Anupana : Luke warm water.

Duration : 45-60 days

Method of Preparation: Raw materials were collected at Sri Srinivasa Ayurvedic Pharmacy,

Srinivasa Mangapuram, Tirupathi.

1. Mandura sodhana[6]

and Marana [7]

-

a) Sodhana- 150 gms of Lauha is taken. It is burnt and dipped in Triphala decoction for 7

times.

b) Marana- The purified Lauha is pounded to powder form in an iron motor and pestle. It is

kept on fire after adding with ghee severe heat is given to the extent that a grass piece

kept on this powder burns out. This process is done for 5 times. Later it is ground along

with juice of Triphala decoction and subjected to Puta for 4 times to get Bhasma of

Lauha.


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2. Mandura vataka formation:

Contents- Guda - 100gm

Nagara - 100gm

Mandura bhasma - 100gm

Tila - 100gm

Pippali - 200gm

a) Take 100gms of dry Nagara [Zingiber officinale Rosc.] make it powder and filter it with

80 number mesh.

b) Take 200gms of dry Pippali [Piper longum Linn.] make it powder and filter it with 80

number mesh.

c) Take 100gms of Guda and Tila [Sesamum Indicum] grinded up to a fine paste.

d) Add the entire ingredients [Guda+ Nagara+ Mandura bhasma+ Tila+ Pippali] roll them

into pills of 250 mg, then make them dry.

Method of Observation

The progress of the patients was observed and recorded accordingly for every15 days. This

process is repeated for the duration of 60 days. After the completion of the duration, the

results were assessed based on the observations.

Criteria for Diagnosis and assessment

A special proforma was prepared incorporating important signs and symptoms of the disease.

At the onset a detailed clinical history was taken and complete physical examination of each

patient was done on the basis of proforma. Hb level below 11 gm% was kept as main

diagnostic criteria for the selection of the patients. Other necessary investigations were

carried out to exclude other pathologies as well as for the assessment of present health status

of the patients.

Considering the overall improvement shown by the patients in signs and symptoms, the total

effect of therapy was assessed in terms of Cure, Moderately improvement and No

improvement as follows:-

Cure - > 75%

Moderately improved – 26 -75%

No improvement - < 25%


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OBSERVATIONS AND RESULTS

For the present study total 40 patients of Pandu roga have been randomly selected from the

OPD and PG. Department of Ayurveda Samhita and Siddhanta, S.V Ayurvedic College

Hospital, Tirupati for this study, each group consists of 20 patients. The patients were

classified into various groups according to the Age, Sex, Diet, Economical Status, Signs and

Symptoms, Occupation and Prakruti etc. Before the commencement of the treatment, the

Signs and Symptoms, Haemoglobin percentage was recorded.

The condition of the patients was reviewed after every 15 days of treatment and same was

continued for a duration of two months and the observations were recorded.

Table No. 1 Distribution of 40 patients of Pandu according to Symptoms

Symptoms Number of patients

Total % Group-A Group-B

Panduta 20 20 40 100

Daurbalya 19 19 38 95

Hridspandana 12 11 23 57.5

Sunakshikuta sotha 5 3 8 20

Rukshata 13 12 25 62.5

Arohanayasa 12 9 21 52.5

Swasa 13 11 24 60

Aruchi 17 14 31 77.5

Pindikodwestanam 7 6 13 32.5

Nidralu 14 12 26 65

Gaurava 17 15 32 80

Karnakshweda 5 6 11 27.5

Bhrama 6 4 10 25

The above mentioned data, reveals that Panduta was observed in all the patients i.e.100%

followed by Daurbalya in 95%, Gaurava in 80%, Aruchi in 77.5%, Nidralu in 65% of

patients. Rukshata in 62.5%, Swasa in 60%, Hridspandana in 57.5%, Arohanayasa in 52.5%

of patients. Pindikodwestanam in 32.5%, Karnakshweda in 27.5%, Bhrama in 25% and

Sunakshikuta sotha in 20% of patients.

Table No. 2 Statistical analysis of Subjective Parameters of Group A

Subjective

Parameters

Group

A

Mean

BT

Mean

AT

% of

Relief X S.D S.E

T

Value

P

value

Panduta 20 3.2 0.75 76.5 2.45 0.825 0.184 13.27 0.0001

Daurbalya 19 2.85 0.6 78.9 2.25 0.91 0.203 11.05 0.0001

Hridspandana 12 1.85 0.45 75.6 1.40 1.42 0.31 4.38 0.0001

Sunakshikuta 5 0.55 0.2 63.6 0.35 0.67 0.15 2.33 0.05


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sotha

Rukshata 13 1.65 0.9 45.4 0.75 0.910 0.203 3.68 0.05

Arohanayasa 12 1.75 0.4 77 1.35 1.26 0.28 4.76 0.0001

Swasa 13 1.75 0.75 57 1.00 0.917 0.205 4.87 0.0001

Aruchi 17 2.1 0.5 76 1.6 0.753 0.168 9.491 0.0001

Pindikodwestana 7 0.7 0.4 42.8 0.30 0.57 0.12 2.34 0.05

Nidralu 14 1.5 0.45 70 1.05 0.82 0.18 5.688 0.0001

Gaurava 17 1.6 0.4 75 1.2 0.69 0.15 7.71 0.0001

Karnakshweda 5 0.6 0.1 83 0.50 0.945 0.211 2.36 0.05

Bhrama 6 0.65 0.25 61.5 0.42 0.69 0.15 2.65 0.05

Table No. 3 Statistical analysis of Subjective Parameters of Group B

Subjective

Parameters

Group

B

Mean

BT

Mean

AT

% of

Relief X S.D S.E

T

value

P

value

Panduta 20 2.75 1.45 47 1.3 0.65 0.14 8 0.01

Daurbalya 19 2.15 1.15 46 1.00 0.648 0.145 6 0.01

Hridspandana 11 1.45 1.00 31 0.45 0.686 0.153 2.93 0.01

Sunakshikuta sotha 3 0.25 0.15 40 0.1 0.307 0.068 1.45 0.05

Rukshata 12 1.55 0.55 64.5 1.00 1.07 0.24 4.156 0.05

Arohanayasa 9 0.85 0.3 64.7 0.55 0.68 0.153 3.58 0.01

Swasa 11 1.35 0.55 59.2 0.80 0.83 0.186 4.29 0.01

Aruchi 14 1.7 0.55 67.6 1.15 0.87 0.195 5.87 0.01

Pindikodwestanam 6 0.65 0.25 61.5 0.4 0.68 0.152 2.62 0.05

Nidralu 12 1.35 0.4 70 0.95 0.88 0.198 4.79 0.01

Gaurava 15 1.75 0.75 57 1.00 0.725 0.162 0.16 0.01

Karnakshweda 6 0.6 0.2 66 0.4 0.680 0.152 2.62 0.05

Bhrama 4 0.4 0.15 62.5 0.25 0.55 0.12 2.03 0.05

Table No. 4 UNPAIRED T TEST [Group A vs Group B]

Symptoms Mean A Mean B Difference between

Means

T

value

P

value

Panduta 2.450±0.184 1.300±0.146 -1.150±0.235 4.875 0.0001

Daurbalya 2.250±0.2036 1.000±0.1451 -1.250±0.2500 5.00 0.0001

Hridspandana 1.400±0.3195 0.4500±0.153 -0.9500±0.354 2.680 0.01

Sunakshikuta sotha 0.3500±0.1500 0.1000±0.0688 -0.2500±0.1650 1.515 0.05

Rukshata 0.7500±0.2036 1.000±0.2406 0.2500±0.315 0.793 0.01

Arohanayasa 1.350±0.2835 0.550±0.153 -0.800±0.322 2.481 0.01

Swasa 1.000±0.2052 0.800±0.186 -0.200±0.277 0.721 0.01

Aruchi 1.600±0.1686 1.150±0.1957 -0.4500±0.2583 1.742 0.05

Pindikodwestanam 0.300±0.1277 0.400±0.152 0.100±0.1987 0.5033 0.01

Nidralu 1.050±0.184 0.9500±0.198 -0.1000±0.271 0.369 0.05

Gaurava 1.200±0.1556 1.000±0.1622 -0.2000±0.2248 0.8898 0.01

Karnakshweda 0.5000±0.2115 0.400±0.1522 -0.1000±0.2606 0.3838 0.01

Bhrama 0.4000±0.1522 0.2500±0.1230 -0.1500±0.1957 0.7666 0.01


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Table No. 5 Distribution of 40 patients of Pandu according to Haemoglobin percentage

Hb%

Number of patients Total %

Group-A Group-B 6-

8gms

16 15 31 77.5 8-

11gms

4 5 9 22.5

In this present study, data in above table shows that 77.50% of the patients had Hb.

percentage between 6-8gm% and in 22.50% patient’s Hb. percentage 8-11gm%.

Table No. 6 Effect of therapy on Haemoglobin percentage of group A

Lab

Finding

N

Mean

score % of

Relief X S.D S.E ‘t’ p

B.T A.T

Hb% 20 7.04 9.93 41 2.89 0.49 0.114 25.94 0.0001

Table No. 7 Effect of therapy on Haemoglobin percentage of group B

Lab

Finding

N

Mean

score % of

Relief X S.D S.E ‘t’ p

B.T A.T

Hb% 20 7.35 9.6 30.6 2.25 0.56 0.12 17.80 0.0001

Table No. 8 UNPAIRED T TEST [Group A vs Group B]

Lab

Finding Mean A Mean B

Differences between

Means T value P value

Hb% -4.195±1.310 -2.250±0.1264 1.945±1.316 1.47 0.01

Table No. 9 Results of therapy in Individual Groups.

Result of Therapy Group A % Group B %

>75% cured 5 25 2 10

26 – 75 Moderate 15 75 18 90

< 25 No improvement 0 0 0 0

In Group A [20 patients treated with Manduravataka] >75% relief of symptoms was

observed in 25% of patients. 26-75 % Moderate relief was observed in 75% of patients.

Where as in Group-B [20 patients treated with Nishamalaki] >75% relief of symptoms was

observed in 10% of patients. 26-75 % Moderate relief of symptoms was observed in 90% of

patients.

DISCUSSION

Research is the systematic and scientific hunt for facts and truth. It is an endeavor to discover

new facts/correlate old facts, by scientific study of a subject. Research is an inevitable part of


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Ayurvedic science because of increased demand for evidence based studies from other

contemporary sciences and international society.

DISCUSSION ON RESULTS

Effect of treatment on different symptoms of the disease

Panduta

Panduta /pallor is the basic sign and indicator of lower Hb levels of Pandu roga, present in

100% patients selected for the present study.

76.5% got relief with Manduravataka. Result was found extremely significant in Group A

(P<0.0001). 47% got relieved from Panduta with Nishamalaki. Result was found highly

significant in Group B (p<0.01).

Manduravataka with Tikta, kashya madhura rasa alleviates Pitta, ignites, digestive fire,

clears the Raktavaha srotas and helps in Uttama rakta dhatu formation with improvement in

Rakta dhatu. Panduta gradually disappears.

Nishamalaki with predominance of Katu, tikta rasa and Bhedana property helps in

maintaining the Srotases clean and healthy there by making the nutrition available to each

and every cell. Amalaki having vitamin C like substance helps in absorption of iron from the

diet there by improving the quality and quantity of iron.

Daurbalya

A subjective parameter indicating diminished energy levels with low percentage of Hb% the

individual experiences weakness and lassitude, fatigue.

After the treatment with Manduravataka extremely significant results i.e. [p<0.0001]. With

78.9% in Group A and highly significant results i.e. [p<0.01] with 46% in Group B [treated

with Nishamalaki].

Hridspandana

Hridspandana was observed only in 57.5% cases. Hridspandana or palpitation is also a

subjective symptom indicating excessive work of heart muscle in order to circulate the low

volume of blood to all parts of the body.


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After treatment with Manduravataka highly significant results i.e. 75.6% were found in

Group A extremely significant i.e. [p<0.0001] and 31% relief found in Group B [treated with

Nishamalaki]. It is highly significant i.e. [p<0.01].

Significant relief/reduction of Hridspandana after treatment indicates improvement in Hb

levels thereby lessening the workload on heart.

Sunakshikuta sotha

This symptom was found only in 20% patients and after treatment with Manduravataka in

Group A 63.6% relief was found while in Group B it was 40% which was statistically

significant.

This indicates the improvement in concentration of interstitial cell volume, due to increase in

Hb% in the blood.

Rukshata

Symptom as a whole was present in 62.5 % patients. Rukshata occurs as a result of

Alparakta, Alpa medha and Nisara which are basic features of Pandu roga. But after

treatment with Manduravataka and Nishamalaki 45.4% of patients got relief in Group A and

64.5% of patients got relief in Group B which is statistically significant (p<0.05).

Because of the Rasayana effects of Amalaki and Pippali nourishment of dhatus occurs and

also the essence of Sapta dhatus- ojas increases and all the Gunas sneha etc. of Ojas also

increase.

Arohanayasa

Arohanayasa means experiencing breathlessness on climbing up/moving upstairs an

important feature of Pandu occurs as a result of demand for o2 from the vital

organs.[inadequate o2 supply to the vital organs] so heart has to work hard to supply o2 to all

vital organs.

In the present study only 52.5% of patients complained of Arohanayasa. After the treatment

was 77% got relief in Group A extremely significant i.e. (p<0.0001) and 64.7% of relief in

Group B which is highly significant i.e. (p<0.01)


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Their significant percentage of relief indicates the improvement in Hb% and an improved o2

carrying capacity of blood resulting in reduced lead over heart.

Swasa

Swasa means difficulty in breathing it also indicates O2 deficit and an increased demand for

O2. It was found in 60% of patients. After the treatment 57% improvement was found in

Group A, extremely significant i.e. p<0.0001 and 59.2% in Group B highly significant result

(p<0.01).

It indirectly indicates the improvement in Hb% and thereby increases in O2 carrying capacity

of blood.

Aruchi

Aruchi means lack of taste for food an important feature of Pandu roga. As already

mentioned Pandu was described under Rasa pradoshaja vyadhi and vitiation of Rasa cannot

occur without the vitiation of Agni. In the present study it was found in 77.5% of patients.

After the therapy 76% of patients got relief in Group A extremely significant results i.e.

(P<0.0001) and 67.6% of patients got relief in Group B highly significant (p<0.01). This

indirectly indicates Agni deepthi and thereby improving Rasa dushti.

Pindikodwestanam

Pindikodweshtanam means gripping pain in the calf muscles. It occurs due to lack of O2

supply to the calf muscles and accumulation of lactic acid in the muscle.

In the present study it was observed in 32.5% of patients. Among them 42.8% of patients got

relief in Group A and 61.5% got relief in Group B. It was statistically significant result in

both Groups.

It occurs as a result of Vata vriddhi due to Rakta kshaya and Medo kshaya with the

improvement in Rakta dhatu, Vata alleiviates and the pain subsides.

Nidralu and Gaurava

Excessive sleepiness was found in 65% of patients in whole study. After treatment 70% got

relief in Group A extremely significant (p<0.0001) in Group B highly significant (p<0.01).

Gaurava means heaviness was observed in 80% of cases. After treatment 75% got relief in

Group A extremely significant (p<0.0001) and 57% in Group B highly significant (p<0.01).


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Both these symptoms indicate diseased strength in the body and results due to Nisara

sithilendriya improvement feature of Pandu. After treatment, with increase in Rakta, both the

symptoms subsided.

Karnakshweda

Karnakshweda means a feeling of sound in the ears. It was found in 27.5 % of patients. After

treatment 83% relief in Group A and 66% in Group B. Both Groups having statistically

significant i.e. (p<0.05).

Karnakshweda indicates Vata prakopa, with Rakta vriddhi and Dhatu pushti vata alleviates

thereby Karnakshweda got relieved in both Groups.

Bhrama

Bhrama means reeling sensation of the head. It was observed in 25 % of patients. Among

them after treatment 61.5% got relief in Group A and 62.5% in Group B. Results in both

Groups found to be statistically significant (p<0.05).

Bhrama indicates Vata pitta prakopa. Pandu is inevitably associated with Pitta prakopa and

with Dhatu kshaya [alpa rakta, alpa meda, nisara] Vata vitiates thus Bhrama results due to

Vata pitta prakopa with alleviation of Pitta and Vata [with Dhatu pushti] Bhrama got

relieved.

Hematological value

In the present study blood samples were tested for Haemoglobin levels before and after the

treatment. After treatment both Groups have shown extremely significant results i.e. 41%

(p<0.0001) improvement was observed in Hb% in Group A and 30.6% (p<0.0001)

improvement was observed in Hb% in Group B.

Overall effect of therapy

After the completion of clinical trial over all assessment of the therapy was done

scientifically and statistically.

In Group A 75% of patients have shown moderate improvement and 25% of patients have

shown complete cure.


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In Group B 90% of patients have shown moderate improvement and 10% of patients have

shown complete cure.

CONCLUSION

Pandu roga is a Pitta pradhana vyadhi. Vata dosha also plays a crucial role in manifestation

of Pandu roga, mainly Vyana vayu has a relation with Samprapti of Pandu roga. Pandu roga

can be effectively compared with Anaemia on the grounds of similarity in signs and

symptoms. In the modern medicine, there is effective treatment for anaemia with

considerable results but associated with certain compromises in the form of side effects,

limitations and in case of chronic nutritional anemias occurring due to deficiency of minerals

and anaemias due to metabolic defects and in born errors no significant therapy is there.

Ayurveda promises a better management of Pandu roga. It is obvious that Anaemia is the

most common ailment among females due to heavy loss of blood during menstruation,

general debility, improper and inadequate diet resulting in malnutrition leading to Anaemia.

The compound preparation Manduravataka comprises of Deepana, Pachana Dravyas that

maintain the Gastric pH by their Tikshna guna and Ushna virya helps to clear the

Srotorodha. With these properties the digestion and metabolism improves ultimately

resulting in proper Dhatu Poshana. Manduravataka is the principal yoga given by Aacharya

Charaka in Pandu roga Chikitsa Adhyaya. This compound helps to correct the disease

pathology and aids in Dhatu Pariposhana and Parinaama krama.

The compound preparation Nishamalaki comprises of only two principle drugs – Nisha [8]

and

Amalaki[9]

. This preparation may not increase the Hb% directly but helps in increasing the

absorption and bio availability of iron to each and every cell from the nutritional sources. On

the other hand it also helps in preventing the complications resulting from anemic conditions.

REFERENCES

1. Yadavji Trikamji Acharya Susrutha Samhita of Susruta with the Nibandhasangraha

Commentary of Sri Dalhanacharya Varanasi; Chaukhamba Surbharati Prakashan;2012.

Sloka [Su.Ut.44/4]; p. 729.

2. Yadavji Trikamji Charak Samhita of Agnivesa, with Ayurvedadipika commentary by sri

Chakrapanidatta Varanasi; Chaukhamba Surbharati Prakashan;2013. Sloka

[Ch.Chi.16/16]; p. 527.


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3. Yadavji Trikamji Acharya Susrutha Samhita of Susruta with the Nibandhasangraha

Commentary of Sri Dalhanacharya Varanasi; Chaukhamba Surbharati Prakashan;2012.

Sloka [Su.Ut.44/5]; p.729.


Chakrapanidatta Varanasi; Chaukhamba Surbharati Prakashan; 2013. Sloka

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[Ch.Chi.16/72]; p. 530.

6. Dattatreya Anant Kulakarni Rasa Ratna Samucchaya, Vol- I, New Delhi Mehar chand

Lachhmandas Publications, 2010; [R.R.S. 5/ 102-103]; p.114.

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8. Prof. K.C. Chunekar BhavaPrakasa Nighantu, Varanasi; Chaukhamba Bharati Academy;

2010, [B.P.Ni. Haritakyadyi varg/ 196-197]; p.111.

9. Prof. K.C. Chunekar BhavaPrakasa Nighantu, Varanasi; Chaukhamba Bharati Academy;

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