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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 25-31

A case–control study to evaluate the etiological factors of Vataja Pandu


1 Department of Roga Nidana Evam Vikruthi Vijnanam, Shri Dhanwantry Ayurvedic College, Chandigarh, India
2 Department of Roga Nidana Evam Vikruthi Vijnana, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Hassan, Karnataka, India
3 Department of Kayachikitsa, Shri Dhanwantry Ayurvedic College, Chandigarh, India

Date of Submission23-Jul-2021
Date of Decision27-Aug-2021
Date of Acceptance09-Sep-2021
Date of Web Publication26-Nov-2021

Correspondence Address:
Dr. Rijin Mohan
Department of Roga Nidana Evam Vikruthi Vijnana, Shri Dhanwantry Ayurvedic College, Sector 46 C, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_39_21

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  Abstract 


Background: Vataja Pandu is a common clinical condition, only generalized etiological factors of Pandu (anemia) are explained in Ayurvedic textbooks. Many studies related to Pandu are carried out, but there is a lacuna of convincing research on risk analysis of each causative factor. Objective: To evaluate the involvement of various etiological factors mentioned in Ayurvedic classics in the causation of etiopathogenesis of Vataja Pandu. Materials and Methods: The present study was a case–control study to determine the exposure of risk factors of Vataja Pandu where 31 subjects fulfilling the criteria of Vataja Pandu were included for the study and considered as case group. Thirty-one healthy individuals were selected from the same geographical area and were taken as the control group detailed history and a questionnaire for Vataja Pandu Nidana was recorded. They were subjected to laboratory investigations. The two groups were assessed based on the questionnaire. Both the groups were analyzed by Kruskal–Wallis test. The odds ratio was calculated and level of significance was analyzed with the help of Chi-square test. Results: When analyzed the odds ratio, following results were obtained such as Katu Rasa (pungent taste) (risk-20.7), Tikshana Guna (penetrating quality) (risk-35.4), Ushna Guna (hot quality), and Tila Taila (sesame oil) (14.28). In Viharaja Nidanas (physical factors) Diwaswapana (day sleep) (risk-73.33), Vyavaya (risk-12.13). Among Manasika Nidana (psychological causes), Chinta (thoughts) (risk-10.4), Srama (stress) and Bhaya (phobia) (risk-8.3), and Krodha (anger) (risk-4.44) show risk for developing Vataja Pandu. Conclusion: Among Nidanas, consumption of Katu Rasa Tikshana, Ushna Guna, Nispava, Tila Taila, Pinyaka, indulgence in Divaswapna, Nidranasha, Vyavaya, Ati Vayayama, Vegadharana, Chinta, Srama and Bhaya and Krodha show significant role in causation of Vataja Pandu when compare to control group.

Keywords: Ayurveda, etiological factors, Nidana, Vataja Pandu


How to cite this article:
Mohan R, Gopikrishna S, Kumar SS. A case–control study to evaluate the etiological factors of Vataja Pandu. AYUHOM 2021;8:25-31

How to cite this URL:
Mohan R, Gopikrishna S, Kumar SS. A case–control study to evaluate the etiological factors of Vataja Pandu. AYUHOM [serial online] 2021 [cited 2022 May 22];8:25-31. Available from: http://www.ayuhom.com/text.asp?2021/8/1/25/331320




  Introduction Top


Pandu Roga is explained under Rasapradosha Vikara[1] and it is classified into 5 types namely Vataja, Pittaja, Kaphaja, Sannipataja, and Mritbakshanajana (due to mud intake).[2] Vataja Pandu has been explained to be caused by indulgenece in Vata Pradhana Ahara and Vihara which leads to the manifestaion of specific Lakshana (symptoms).[3] Twak Vaivarnya especially blackish discoloration of the skin is the common criteria for diagnosis of Vataja Pandu.[4] The literary review of research updates about the etiological factors of Vataja Pandu reveals a lacuna in assessing the risk of each etiological factor. On understanding of which can help in recommendations of Nidana Parivarjan in the Vataja Pandu patients. The etiological factor of Vataja Pandu can be classified into Aharaja, Viharaja, Manasika, and Anya Nidana (other etiological factors).[5] Among the Samanya Nidana of Vataja Pandu, Vata Pitta predominant Nidana is separated and analyzed. The Aharaja Nidana is further separated based on Rasa (taste), Guna (quality), and Dravya (substance). Anya Nidanas include Jwara Peedita (due to fever), Raktha Srava Peedita (due to blood loss), Roga Peedita (due to chronic diseases), etc., which can also contribute in the manifestation of Vataja Pandu. Therefore, by knowing specific Nidana of Vataja Pandu, one can avoid the chances of being affected by Vyadhi (disease) following Nidana Parivarjana (avoiding of etiological factors) as well as it also helps in deciding accurate treatment leading to better prognosis.

Objectives of the study

To determine the etiological factors mentioned in Vataja Pandu Nidana.


  Materials and Methods Top


Institutional ethics committee details

Institutional ethics committee clearance has been obtained before starting the study vide letter no. SDM/IEC/58/2017–18.

Method of collection of data

Inclusion criteria

Case (Vataja Pandu):

  • Patients of either gender of age group 16–60 years
  • Patients fulfilling Vataja Pandu Lakshana
  • Hemoglobin <11-g percentage and more than 6g percentage
  • Patients who are willing to participate in the study and ready to give written consent.


Control (healthy individual):

  • Healthy individuals matched with both gender and age group 16–60 years
  • Individuals of the same locality as that of case
  • Healthy individuals who are willing to participate in the study and ready to give written consent.


Exclusion criteria

  • Person suffering from diseases like diabetes mellitus
  • Hemorrhagic diathesis such as hemophilia
  • Other types of Pandu.


Sampling method

  • Convenient sampling.


Bird eye view of the study

Thirty-one subjects fulfilling the diagnostic and inclusion criteria of Vataja Pandu were included for the study, detailed history was recorded in especially designed case pro forma, and taken as case group. They were subjected to laboratory investigations as mentioned below. Questionnaire for Vataja Pandu Nidana is designed based on Vata and Pitta Prakopa Nidanas among Samanya Nidanas of Pandu Roga collected from various ayurvedic textbooks. Further, these Nidanas were systematically categorized into different domains such as Aharaja, Viharaja, Manasika, and Anyaja. Aharaja Nidanas further categorized based on Rasa, Guna and Ahara Dravya. Under each domain each item is given with 5 point Likert scale with categories as “regularly” (7 days a week), “frequently” (4–6 times a week), “sometimes” (2–3 times a week), “occasionally” (1 time a week) and “never” (not consuming/not responded). At the same time, 31 healthy individuals were selected from the same geographical area and were taken as the control group and the same questionnaire was given to them. The two groups were assessed based on the questionnaire [Figure 1]. Both the groups are analyzed by Kruskal–Wallis test to see the level of significance. At the same time based on scoring in Likert's scale score ≤2 is considered as not consuming and score more than 2 is considered as consuming. The odds ratio is calculated between the Vataja Pandu and healthy subjects. The level of significance between both groups is analyzed with the help of Chi-square test. This helped to identify the role of various Nidanas explained in classics in the manifestation of Vataja Pandu.
Figure 1: Showing bird eye view of study

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Diagnostic criteria

Subjective parameters

Below listed symptoms of Vataja Pandu collected from various Ayurvedic textbooks have been considered as subjective parameters.

Investigations:

  • Hemoglobin (HB) percentage
  • Hematocrit (packed cell volume [PCV], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC], red cell distribution width [RDW]).



  Observations and Results Top


Among Aharaja Nidana, consumption of Katu Rasa, Tikshana Guna, Ushna Guna, Nispava, Tila Taila, and Pinyaka show risk of developing Vataja Pandu. Indulgence in Viharaja Nidanas such as Divaswapna, Nidranasha, Ati Vyavaya, Ati Vayayama, and Vegadharana shows risk of occurrence of Vataja Pandu. Subjects having Manasika Nidanas such as Chinta, Srama, Bhaya, and Krodha show risk for developing Vataja Pandu.


  Discussion Top


Among the Vataja Pandu Lakshanas, Krishna Pandutwa (blackish discoloration of skin), Angamarda (body ache), Balakshaya (debilitate), Varcha Sosha (reduced quantity of stool) are observed in all the Vataja Pandu subjects (n = 31), which may be due to the Vata Prakopa. Asyavairasya (altered taste sensation), Anaha (bloating), and Varcha Sosha have been reported by 27 subjects. The Asyavairasya may be a contribution of Prakupita Pachaka Pitta and Vishamagni. Anaha and Varchasosha may be due to vitiation of Apana Vata.

Discussion on laboratory investigation

The reduced Hb% [Table 1] can be considered as Dusti of Ranjaka Pitta because of which the improper Rasaranjana happens. The observation on PCV in 31 patients of Vataja Pandu shows that 20 samples have reduced PCV value indicating Alpa Rakthata in the patients which is the Samanya Lakshana of Pandu. The MCV observations of Vataja Pandu subjects show that most (19) of the samples have reduced MCV below 70fL indicating the reduced average red blood cell (RBC) count in blood.[6] This also contributes in Alparakthata diagnosis in patient. MCHC count indicates that reduced Hb% in patients pertain to improper Rasa Ranjana resulting in Pandu Varna. RDW indicates the red blood distribution width that is quantitative measure of anisocytosis and is expressed in percentage. Most of the patients with Vataja Pandu (19) come under normal range of RDW that is 35%–46%. Hence, it indicates that no much change in size of RBC was observed in the present study.
Table 1: Hemoglobin percentage distribution of 31 patients of Vataja Pandu

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Discussion on Aharaja Nidana

Even though Lavana is explained as one among the Nidanas of Pandu, on comparing both case and control, it does not show a significant (H = 0.134) role as a risk factor in causation of Vataja Pandu.

Katu Rasa in excessive usage brings about Vata Pitta Prakopa, causing increase of Gunas such as Laghu, Ruksha (Vata), Ushna, and Tikshana (Pitta). It also causes Meda Kleda Shoshana and will produce Balakshaya, Kampa, Angamarda, Alpa Meda, and Indriya Dourbalya[7] which are the Lakshanas of Vataja Pandu. The risk estimated by odds ratio is 20.07 and the obtained H-value is statistically significant, which shows that in individuals with regular (daily) intake of Katu Rasa having 20.07 times more chance of occurring Vataja Pandu compared to individual not consuming it.

Kashaya Rasa possesses Seeta, Ruksha Guna which in turn does Vata Prokapa. It also does Soshana of Kleda and Medha which contribute to Alpa Medas, produces Adhmana, Parushya (roughness to body), constipation by Ruksha Seeta Guna Vriddhi.[8] The risk estimated is 1.55, thus it can be understood that in this study, “occasional” consumption of Kashaya Rasa (H-value 0.010) does not contribute as risk factor in causation of Vataja Pandu.

Ushna Guna causes the Pitta Dosha Vriddhi which result in Bhrama pertaining to Vataja Pandu.[9] Increase of Ushna Guna consumption causes Tikshna Agni which leads to improper absorption, which also contributes to Bala Kshaya and Ojo Kashaya. In this study, risk factor cannot be calculated, so it can be considered that “regular” (H-value 0.001) consumption of Ushna Guna Ahara contributes in Vataja Pandu manifestation. Tikshna Guna consumption in excess causes Pitta Prakopa, especially Pachaka Pitta Dusti,[10] which hinders the Ahara Pachana and formation of Rasa Dathu. It effects the nourishment of Raktha Dathu which causes the manifestation of Alpa Raktha. The risk estimated between the Vataja Pandu and healthy individuals is 35.4 shows that the individuals who does “regular” (H-value 0.001) consumption of Tikshna Guna Ahara have 35.4 times more chance of developing Vataja Pandu, when compared to individuals not consuming it.

Nispava is Vata Vardhaka and vitiates Pitta and Raktha, it also induces Ushna Guna Vriddhi,[11] which causes Agnivaishmya and results in Vataja Pandu. The estimate risk is 11.97, which indicates that even weekly 2–3 times (H-value 0.001), consumption of Nispava is acting as a risk factor in the causation of Vataja Pandu. Nispava which is identified as Dolichos lab, on animal study shows potential stimulation (β-conglycinin) of cholecystokinin secretion from enteroendocrine cells. It plays a major role in stimulating pancreatic enzyme secretion, gallbladder contraction, (pitta vridhi) inhibition of gastric emptying (Adhmana and Vibanda), and appetite suppression.[12]

Pinyaka causes increase of Ruksha Guna Vridhi leading to Vata Prakopa, especially Apana Vata Prakopa.[13] The Prakupita Apana Vata does Soshana of Mala and results in Varcha Sosha and hard stools. It may also bring about Twak Rukshata, fatigue, and constipation which are the symptoms of Vataja Pandu. It is concluded that in this study, “occasional” (H– value 0.02) intake of Pinyaka contributes in causation of Vataja Pandu [Table 2].
Table 2: Comparison on consumption of Aharaja Nidanas between Vataja Pandu and healthy individuals along with risk estimation

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Tila Taila possesses the qualities such as Tikshna and Ushna, which does Pitta Prakopa,[14] especially Pachaka Pitta. It results in Ksheena Avastha of Rasa Dhatu which results in less nourishment of Raktha Dhatu causing Alpa Rakthata. The odds ratio estimation reveals the risk value of 14.28. The obtained H-value is statistically significant (0.001) with weekly 2–3-day consumption of Tila Taila that contributes as a risk factor in causation of Vataja Pandu.

In this study, the obtained H-value (0.623) between the groups does not show any statistical significance.

Discussion on Manasika Nidana

Srama causes Vata Prakopa[15] leading to Vishamagni. This hampers Parinama of Rasa to Raktha which results in Vataja Pandu. Limited utilization and transport of hepatic iron are noticed in stress-induced rats, and hence, stress can contribute in reduced Hb levels.[16] Risk cannot be calculated in this because all the Vataja Pandu patients experience Srama. People with mental stress “regularly” (H– value is 0.001 < 0.05) are at risk of Vataja Pandu.

Ati Chinta causes Vata Prakopa[17] by increasing Chala Guna and Athi Chinta results in Rasavaha Srotodusti[18] and impairs Raktha Dhatu Poshana resulting in Vataja Pandu. The computed risk by seeing odds ratio is 10.4, so the study finds that individuals who are worried “regularly” (H-value 0.001) are at risk of developing Vataja Pandu.

Due to Krodha, Pitta Prakopa[19] occurs especially Sadaka Pitta, Rasa Dhatu being the seat of Pitta Dosha, Dushana of Rasa occurs leading to hindrance in Raktha Dhatu Poshana resulting in Vataja Pandu manifestation. In spite of consuming Pathya and Hita Ahara (wholesome food) if an individual indulges in Krodha, it leads to Ajeerna (indigestion).[20] The risk estimated is 4.44, which means that people who have anger 2–3 times in a week (H-vale 0.001) are at risk of developing Vataja Pandu.

Bhaya induces Vata Vriddhi,[19] especially Samana Vata which results in Agnivaishamya which also may contribute in improper Pachana of Ahara Rasa and may end up in poor nourishment of Raktha Dhatu and other presiding Dhatus causing Vataja Pandu symptoms. The risk estimated is 8.3. It reveals that those individuals reporting fear 2–3 days a week (H-value, 0.001 < 0.05) are at a risk of developing Vataja Pandu. Kama (desire) in excess will cause Vata Prakopa[21] which also contributes in the causation of Vataja Pandu. The risk obtained by calculating the odds ratio is 3.65, and hence, Kama may contribute as a risk factor in developing Vataja Pandu in individuals having desire 2–3 days in a week (H-value 0.039 < 0.05).

Shoka in excess will cause Vata Prakopa and results in Agnivaishamya,[19] producing symptoms such as Aruchi, etc., The estimated risk between the case and control on Shoka is 8.23, which highlights that the individuals exposed to Shoka frequently (4–6 days a week) are at a risk of developing Vataja Pandu (H-value 0.001) compared to healthy individuals [Table 3].
Table 3: Comparison on consumption of Manasika Nidanas between Vataja Pandu and healthy individuals along with risk estimation

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Discussion on Viharaja Nidana

Diwaswapana is one among the Nidanas of Agnimandhya,[22] which further causes improper formation of Ahara Rasa. This hampers the rasa Dathu Poshana causing poor nourishment to Raktha Dathu which leads to Vataja Pandu. Agnivaishamya plays a vital role in the pathogenesis of Vataja Pandu, Diwaswapana contributes to it. The estimated risk is 73.33, indicating that people indulging in Diwaswapana regularly (daily) are at a risk in the development of Vataja Pandu (H-value 0.001).

Ati Vyayama will cause increase in Laghu and Chala Guna of Vata which contributes to the pathogenesis of Vataja Pandu. It also does Medho Kshaya[23] where Alpa Medas is one among the Samanya Lakshanas of Pandu. The obtained risk value on calculating odds ratio is 12.13 this indicates that individuals who indulge in Athi Vyayama, 2–3 times a week (H-value 0.001) is at the risk of developing Vataja Pandu.

Athi Vyavaya causes increase in Ruksha, Laghu, and Ushna Guna of Vata and also produces symptoms such as Bhrama and Dhatu Kshaya.[24] The risk estimated is 7.20, so in this study, we can conclude that Ativyavaya is a risk factor in causation of Vataja Pandu. Since the obtained H-value is 0.377 which is >0.05, it does not show any statistical significance so we cannot tell how often indulging in Ati Vyavaya, as risk factor for Vataja Pandu.

Vegadharana especially Mutra and Pureesha Vegadharana produces Vata Prakopa and results in symptoms such as Siroruja, Anaha, Vibanda.[25] The risk obtained by calculating the odds ratio is 3.32. It can be interpreted that individuals indulging in Vegadharana “sometime” (2–3 time a week) are at 3.32 times risk of developing Vataja Pandu (H-value 0.03) compared to individuals not indulging in it.

In this study, there is no significant difference between case and control (H-value 0.194) and estimated risk is 1.54 thus walking for long distance is not acting as a risk factor in developing Vataja Pandu.

Nidranasha causes Ruksha Guna Vriddhi of Vata, it produces Angamarda, Bhrama, and Vata Pradhana Vikara.[26] Since all the patients of Vataja Pandu presented with Nidranasha (n = 31) risk estimation is not possible, the obtained H-value (0.001) which is statistically significant reveals that subjects who are daily indulging loss of sleep at are at risk of developing Vataja Pandu [Table 4].
Table 4: Comparison on consumption of Viharaja Nidanas between Vataja Pandu and healthy individuals along with risk estimation

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Discussion on Anya Nidana

In both case (n = 31) and control (n = 31) group, none of the subjects reported with Panchakarma Apachara. Hence, in this study, Panchakarma Apachara cannot be considered as a risk factor in causation of Vataja Pandu.

Among the subjects of Vataja Pandu, 6 subjects (19.4%) presented with a history of bleeding whereas 25 (80.6%) did not report it. The Chi-square test value obtained is 6.60 with P value 0.01 which is <0.05 which is statistically significant. Hence, Raktha Sravapeedita acts as risk factor in manifestation of Vataja Pandu. Out of 6 samples, 1 subject reported with a history of bleeding during surgery whereas 5 subjected with increased menstrual bleeding. Excessive blood loss will lead to Ruksha Guna Vriddhi which causes Vata Prakopa[27] that results in Raktha Dhathu Kshaya causing Vataja Pandu Lakshanas [Table 5].
Table 5: Comparison on consumption of Anya Nidanas between Vataja Pandu along with P-value and estimated risk

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  Conclusion Top


From the case–control study, it can be concluded that among the Aharaja Nidanas explained in Ayurveda classics, the individuals who regularly consume Katu Rasa Tikshana Guna, Ushna Guna, and “sometimes” (2–3 times a week) consumption of Nispava, Tila Taila, and Pinyaka show risk of developing Vataja Pandu. “Regular” indulgence in Viharaja Nidanas such as Divaswapna, Nidranasha, Vyavaya and “sometimes” (2–3 times a week) indulgence in Ati Vayayama and Vegadharana show risk of occurrence of Vataja Pandu. Subjects having “regular” Chinta, Srama and “sometimes” (2–3 times a week) Bhaya and Krodha show risk for developing Vataja Pandu. Anya Nidanas such as Jwara Pedita and Raktha Srava Pedita also play a role in Raktha Dathu Kshaya and contribute in causation of Vataja Pandu. Improper Ahara Parinama developed due to impaired Agni which is caused by Prakopa of Pitta (Pachaka and Ranchaka) and Vata (Samana and Apana) results pathognomic sequel of Vataja Pandu. Hence, avoiding the above-discussed risk factors will help in reducing the chance of developing Vataja Pandu.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Materials and Me...
Observations and...
Discussion
Conclusion
References
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