WhatsApp Discussion Series 49: 'Pandu-samprapti' & related 'Vidagdhata' by Prof. Satyendra Narayan Ojha, Prof. Hrishikesh Mhetre, Prof. Mamata Bhagawat, Vd. Vinaya Ballakur and others.

Ch.Chi.16 ;

The aetiological factors described for Pandu Roga are in majority, Pitta vitiating ones, which mostly are also Rakta vitiating factors,  while only few are predominantly Vata or Kapha aggravating ones. The diet and the lifestyle pattern as described by the Acharyas as the causative factors has changed a lot, hence a description of what they may pertain to in the present era has been given below. 

Amla Ahara may be taken as today with foods with predominance of tomatoes, sour curd, lemons, citric acid, pickles, and food with preservatives as jams, cold drinks, sauces, Imli etc.

Lavana Ahara may be taken as food with excess salts or with salt added from above as pickles, Chatnies etc.

Madya may be taken as alcoholic beverages as rum, beer, whisky, vodka etc.

Kshara may be taken as soda while, Ati Teekshna Ahara may be taken as excessively spicy items as Chhole, Chats, Pakore, Panipuri, Chaps, Razma, spicy vegetables and other dishes.

Ati Ushna may be taken as food articles which are either very hot as tea, coffee etc. or which increase the metabolic activities of the body or also as very hot temperature.

Mrittika Bhakshana may be considered as either oral ingestion of mud or use of articles contaminated with mud as unclean hands and fingers or as improperly washed vegetables or eatables.

Viruddha Bhojana may be taken as mutually contradictory foods - a whole list of which is available in Ayurvedic texts.

Asatmya ,Bhojana may be taken as food items to which an individual is not adopted or suited. It may be considered as sudden change of food style or habit or also as Junk food used today, as they are not beneficial.

Amongst the etiological factors related to Vihara (lifestyle) are- 

excessive exercises or physical stress, excessive sexual practices, holding of the natural urges especially urine, stool, flatus or vomiting; not following the seasonal regime (diet, lifestyle and seasonal cleansing measures) as described in the texts, sleeping during the day, excessive physical activity before the digestion of the food etc.

Various Manasika Hetus (mental factors) have also been described as excessive worry, psychological stress, anger, fear, grief, passion etc. to have a role in the causation of Pandu Roga which are an integral part of today’s lifestyle and are inescapable. Studies have suggested the role of some of these psychological factors in the causation of anemias.

A lot of scientific studies of the modern medical science have proven the role of some of the Aharaja factors in the causation of Pandu Roga as tea (considered as Ati Ushna Nidana) has been proved to cause iron deficiency anemia by interfering with the absorption of iron. Similarly Madyas (alcohols) cause megaloblastic anemia by hampering the folate absorption. However, the role of many of the dietary factors as described by Ayurveda have not been confirmed till now through scientific studies.

REVIEW ;

Aahar/Nutritional status: - A complete diet is very essential for all dhatu utpatti. Knowledge of hetus mentioned below and there action in causing pandu is essential:

Ati kshar:- Kshar has katu and lavana rasa in predominance. It has ushna , tiksna and laghu guna and has quality of pacana, dahana, bhedana, it is hridya and pustava upaghatkar. Especially kshar is so called depending on the function of chithva chithva aashayat kshar i.e. it causes ulceration of aashaya. Gastric ulceration is cause for vitamin B12  deficiency also a cause for haemorrhage (malena). Erosive gastropathy, atrophy of gastric parietal cell is cause for cobalamin malabsorption leading to pernicious anaemia.

Further katu rasa is said to be shonita sanghata bhinnati i.e. cause for haemolysis.

Amla rasa when taken in excess is cause for pitta vridhi, rakta dusayati and mansa vidahati. Ati amla changes that acidic pH and are cause for amlapitta [GERD] again cause for grahani thereby leading to pandu. Further as explained in Ca. Ci. 15/49 the annavisha when comes in contact with rasadi srotas causes rasa pradoshaja vikar i.e. if annavisha gets lodged in rasavaha srotas it is cause for pandu.

Lavana rasa   when used in excess pitta prakopa and rakta vridhi is seen.  rakta vridhi is drava rupa vridhi i.e. fluid overload (hypervolaemia) which causes decreased haemoglobin concentration and apparent anaemia. Modern explains general cause of hypervolemia includes excessive sodium or fluid intake, sodium or water retention and fluid shift into intravascular space. Excessive intake of Lavana rasa causes decrease of prithvi mahabhuta in rakta and increase of aap mahabhuta in rakta dhatu. Acharya Caraka explains lavana to be cause of amlapitta again as discussed above cause for grahani and pandu.

Viruddha and asatmya bhojan are cause for grahani too i.e. malabsorption as discussed in Grahani dosha chikitsa adhyaya thus leading to rakta poshak rasa sara bhag alpata.

Nispava, masha, pinyaka, tila taila are hetu explained for rakta dusti in Vidhishonitya adhyaya (Ca. Su. 24) and Raktpitta adhyaya (Ca. Ni. 2) where it is cause for pitta and rakta vitiation and vatarakta chikitsa adhyaya (Ca. Ci. 29) where it is cause for rakta dusti. Further these food ingredients have low nutritional values essential for rakta formation i.e. there is rakta poshak rasa bhag alpata.

Vidagdha anna:- partially cooked /partially digested food acts like one of cause for agni dusti thereby leading to suktapaka which acts like visha as explained in grahani adhyaya, again a cause for malabsportion.

Divaswapa:- Especially just after eating meals, is one of the cause for kaphaja grahani. Peristalsis is also reduced by heavy meals causing bacterial overgrowth. Bacteria deconjugate conjugated bile acids to unconjugated bile acids and as a result intra-duodenal concentration of bile acids will be reduced resulting into steatorrhoea and macrocytic anaemia.

Vyayama or excessive exertion and excessive sexual intercourse are both explained as hetu in kshaya vyadhi. Ativyayama is one of the causes for sahas janya rajayakshma and ativyavaya is caused for kshaya janya rajayakshma. In both condition sneha guna undergoes kshaya which is cause for kshaya or rasa dhatu rupi oja kshaya. (Ca. Ci. 8). Ativyavaya is cause for shukra kshaya thereby affecting varna of sharira. Acharya Sushruta has explained vyavaya as the first cause of pandu.

Vega dharan aggravates vata which has impact mainly on neural stimulation of digestive secretion thereby affecting digestion leading to grahani and pandu.

Pratikarma:- When samyaka yoga of vamanadi shodhana karma are not  observed has its impact on digestive system. Ayoga of Panchkarma is one of the cause for sukta paka there by causing annavisha which when lodge in rasavaha srotas is case for pandu. Further ayoga of Panchkarma also has have impact on gut microbiome.

 Rutu vaishamyata has impact on digestive power and accordingly if diet is not changed it leads to agnimandya thereby leading to shuktapaka  and pandu.

 Manasik hetu is cause for agnimandya. In Ca.Vi.2/9 mānas hetus have been explained which causes agnimāndya. Psychological pervasions have shown to either cause excessive enzymatic secretion or inhibit enzymatic secretion thus a normal pH is not maintained in the gastrointestinal tract. Research in animals shows psychological stress is associated with elevated cytokines IL-6 and TNF alpha. Exposure to stress resulted in reduction in microbial diversity and richness. The brain can exert a powerful influence on gut bacteria even mild stress can tip the microbial balance in the gut making the host more vulnerable to infectious disease and triggering a cascade of molecular reaction that feedback to central nervous system. Agnimandhya causes rasa sara bhag alpata leading to pandu.

Other hetu includes bija dusti Ca. Sa. 4/30. Rakta, mansa and meda are matruja avayava therefore any dusti in matruja bhaga can cause pandu for eg. Congenital dyserythropoietic anaemia which is cause for ineffective erythropoiesis. Intrinsic (intracorpuscular) abnormalities cause premature destruction. All of these, except paroxysmal nocturnal hemoglobinuria, are hereditary genetic disorders. Hereditary spherocytosis is a hereditary defect that results in defects in the RBC cell membrane, causing the erythrocytes to be sequestered and destroyed by the spleen. Hereditary elliptocytosis is another defect in membrane skeleton proteins which also leads to anaemia.

[2/1, 10:14 PM] Prof.  Mamata bhagwat: 

Thank you for sharing Sir !

What is actually the meaning of vidagdhata.

Vidagdhata of ahara, rasadhatu, rakta, and many more factors. How it could be explained rationally Sir ?

[2/1, 10:16 PM] Prof. satyendra ojha sir: Go in details with all...

[2/1, 10:18 PM] Prof. satyendra ojha sir: 

Pressure cooker making food also comes under vidagdhatā...

[2/1, 10:28 PM] Vd Vinaya Ballakur: 

Vidagdhata is related to pitta. May be understood as opposite of Sama dagdhata ( proper cooking).

So it can mean improper cooking of food.

Ajirna context makes things clear.

Vishtabdhata due to vata, vidagdhata due to pitta

Amajeerna due to kapha....

Also in amlapitta,

amlam vidagdham cha .....

[2/1, 10:29 PM] Prof. Hrishikesh mhtre: 

True.

Sharngadhara,

In kvaatha adhyaaya,

Sa pidhaana (with cover) paaka(cooking) is said to be durjara(difficult to digest) & vidagdha.

[2/1, 10:30 PM] Prof. satyendra ojha sir: 

Zollinger - Ellison syndrome is best example of vidagdha pitta..

[2/1, 10:37 PM] Prof. Mamata bhagwat: Thank you Vinaya mam.

[2/1, 10:37 PM] Prof. Mamata bhagwat: Thank you sir !

[2/1, 10:39 PM] Prof. satyendra ojha sir: 

Ketoacidosis is best example of vidagdha Rakta..

[2/1, 10:40 PM] Dr Surendra A Soni: Great !

[2/1, 10:43 PM] Prof. satyendra ojha sir: 

Param tu pachyamānasya vidagdhayāmlabhāvatah .. ch.chi.15

[2/1, 10:44 PM] satyendra ojha sir: Vidagdhasyāmlabhāvatah*

[2/1, 10:45 PM] satyendra ojha sir: Varshāsu vidahatyannam...

[2/1, 10:48 PM] Prof. Hrishikesh mhtre: 

No Sir. If decided, can be avoided for sure.

1 adjustment can be suggested ...

सुधौतः *प्रस्रुतः स्विन्नोऽत्यक्तोष्मा* चौदनो लघुः॥३०॥

This is ideal. Strain out peyaa ... Well cooked, served hot ...

But if not possible, then

*1 यश्चाग्नेयौषधक्वाथसाधितो & 2 भृष्टतण्डुलः।*

Cook with dhanyaka jeeraka aardraka.

Roast the rice grains prior to cooking.

This adjustment nullifies daily aahara hetu of amlpapitta/pitta kapha vidagdhata.

[2/1, 10:49 PM] satyendra ojha sir: Great Approach.. 

[2/1, 10:57 PM] Dr Jayshri Kulkarni:

क्रोध-संताप  is mentioned in शोणितसंप्रदोष हेतु .

विदाहश्चान्नपानश्च तिक्ताम्लोद्गिरणं क्लमः l

 R mentioned as शोणिताश्रित विकार.

 I come across many such patients, relieved by establishing habit of chanting " वदनी कवळ घेता....." And keeping away mobile T V , I phone etc . 15 minutes before meals.

[2/1, 11:31 PM] Prof. Mamata bhagwat: 

So it is clearly understandable that,Vidagdhata at the level of ahara, ahara rasa, rasadhatu, rakta, mamsa like that... Is causing inflammatory changes in the respective dhatu or factor.

In metabolic activities at various levels the information is quite possible. It leads to formation of inflammatory markers- specific or non specific.

This information is the cause for all metabolic disorders including cancer, diabetes, gout, thyroiditis etc,

Pitta dosha- paka karma impairment is responsible here...

Kala kale virechana / shodhana will be helpful? This is what we can think why *kaale shodhana* to avoid disorders like prameha was mentioned?

Vidagdhaajeerna at various levels *(ajeerna cannot be restricted to jatharagni alone)* be tackled and metabolic disorders could be thus avoided ?

This is my intention of trying to decipher and elaborate on Vidagdhata.

Thank you all respected vaidya gana for giving valuable inputs.

[2/1, 11:40 PM] Vd Vinaya Ballakur: 

Saama dhatu is described not vidagdha dhatu.

Vidagdhtata is limited upto rakta. Rakta and pitta are similar. Maybe that's why vidagdha aahara affects rakta.

[2/1, 11:44 PM] Vd Vinaya Ballakur: 

Inflammatory changes in body maybe studied better by looking at saama dhatu , I feel...

[2/1, 11:48 PM] Prof. satyendra ojha sir: 

Svena ( doshāgni ) is major concern in inflammation..

[2/1, 11:51 PM]  Prof. satyendra ojha sir: 

Abhighātaja jvara (āchārya charakokta) is best example of inflammation..

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Above discussion held on 'Ayurveda Peetha"(initiated by Prof. S.N. Ojha) a Famous WhatsApp group of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

EMAIL: surendraasoni@gmail.com

Mobile No. +91 9408441150