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ASSESSMENT OF HEMOGLOBIN PERCENTAGE OF ADOLESCENT FEMALE’S RESIDING IN RURAL AREAS OF NIGDI VILLAGE W.S.R. TO ETIOPATHOGENESIS OF PANDU VYADHI Patil Ragini Rajan*, Kulkarni Yogini Ramchandra College of Ayurved and Research Center, Nigdi, Pune, Maharashtra, India Received on: 11/02/12 Revised on: 21/04/12 Accepted on: 17/05/12 *Corresponding author Dr. Ragini Rajan Patil (M.D. Ayurved), College of Ayurved and Research Center, Sector No. 25, Nigdi, Pradhikaran, Pune 411044, Maharashtra, India Email: patilragini26@yahoo.in ABSTRACT Hemoglobin estimation was done in adolescent females, aged between 10 to 18 years, residing in slum areas of Nigdi village for etiopathogenesis of Pandu / anemia. Relation between Hetus and their subsequent Lakshanas were established by statistical analysis; proportion of two variables and result was found to be significant as Hetu and Lakshanas do not differ significantly. On the basis of observation, prevalence of Tridoshaja Pandu was found in the area taken for the study with 5 percent level of significance. Keywords: Hemoglobin estimation by Sahli’s method, Pandu/anemia, Relation between Hetu and Lakshana of Pandu. INTRODUCTION According to WHO population of India is about 1.2 billion which accounts for world's 17.5 percent population, is the 2nd largest after China. The birth rate is about 1 baby in every 10 seconds. So the population of India goes on increasing day by day9. Approximately 55 percentage people are living below poverty line. Due to increase in population, poverty is also increasing. To overcome this poverty, industrialization is on the rise in urban areas. So the people are moving from their villages towards cities and thus population in cities is increasing leading to more poverty. The increase in population and poverty is leading to more slum areas which ultimately results in dirty and unhygienic conditions. Along with unhygienic condition malnourishment and faulty dietary habits are increasing which results in various types of diseases. Therefore Vyadhi’s like Pandu (Anemia) is more prevalent in such type of areas. Pandu is a Pitta pradhana vyadhi. Due to hetu sevana, Pitta dosha gets vitiated along with other doshas and is circulated in the whole body causing shithilata in all Dhatus which ultimately hampers normal functions of Dhatus. Decrease in Dhatusnehatwa forms Nih-sar Dhatu and decrease in Rasa-Rakta Dhatu along with Oja-Guna results in Pandu Vyadhi. According to modern science, Pandu is a disease characterized by pallor of body, occurs due to reduction of hemoglobin, number of RBC’s per cu mm of Blood resulting in pallor symptoms1-4. Even though awareness about healthy food and nutritious food has increased and production of food rose, a lot of population still suffers from Pandu. The incidence of Pandu is found in both higher and low socio economic class. Incidence of Pandu in today’s world has gone to a rise because of people’s irregular, altered food habits, consuming bakery products, fast foods and having food at wrong time thus not following Ashtawidha Ahar Visheshayatana. According to Ayurveda Ushna, Tikshna, Kshar, Amla, Lavan Ahara and Diwaswap, Ratri Jagaran, sedentary lifestyle, lack of exercise Vihara, are

responsible for development of Pandu in Upper socioeconomic class. While lack of food, Kshudha-Vega-Nigraha, heavy alcohol consumption, addictions, illiteracy, exertion, heavy work etc are the cause for development of Pandu in Lower socio-economic class. Kama, Chinta, Bhaya, Krodh etc Manasik hetus is playing a major role in development of Pandu in both Higher and Lower class1-4 According to WHO estimates, over one third of population suffers from Anemia and India continues to be one of the countries with very high prevalence rate. National Family Health Survey 3 reveals Prevalence of Anemia to be 70 to 80 percent in Children, among which 50 to 60 percent is seen in adolescent females; Age group between 10 to 18 years. Anemia is also seen, 70 percent in pregnant women and 24 percent in Adult Men. The Prevalence of Anemia in India is high, majorly due to poor diet and worm infestations7-8. Pimpri-chinchwad Corporation has many slum areas where prevalence of Pandu has been seen and many cases have been registered till now in various Government and private Hospitals. Thus in present study of assessment of Hemoglobin percent in adolescent females, Hetus, Lakshanas and types of Pandu Vyadhi has been studied. The Government of India is taking many steps for diagnosis and treatment of Pandu/Anemia by conducting Hemoglobin camps and health check up camps through various Government and Private hospitals or registered Pathology labs. Aim To assess Hemoglobin percentage in adolescent females residing in rural areas of Nigdi village. Objectives To compare and observe the etiological factors (hetu), Lakshanas mentioned as per samhita in adolescent females having hemoglobin percentage range in between 5 to 10. To test cause and effect relationship between Hetu and Lakshanas as per vitiation of Doshas.

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Hypothesis Predominance of Pandu, in Adolescent females living in slum areas has low Hemoglobin percent level. The relationships between Hetu and Lakshanas of Pandu Vyadhi are observed as per Samhitas. MATERIAL AND METHODS Materials Literature review was done from classical Ayurvedic texts, Modern literature and Web references regarding Pandu and Anemia. Scope and Limits 650 female subjects having age between 10 to 18 years were screened from slums area of Nigdi village. Sahli’s Hemoglobinometer kit was used for Hemoglobin

estimation5.Special designed case record form was used of observations. Methodology Literature reviews regarding etiopathogenesis of Pandu and Anemia from necessary library resources were reviewed. 650 female subjects were screened for Hemoglobin percent with the help of Sahli’s hemoglobinometer. The subjects ranging 5 to 10 gm Hb percent were taken for the present observational study of etiopathogenesis. The standard procedure mentioned in the book Medical Laboratory Technique by Godkar was performed for Hemoglobin estimation5. The special case record form was designed regarding Hetu and Lakshanas of Pandu Vyadhi mentioned in classical Ayurved text.

Table 1: Aharaj hetu wise distribution

Sr. No Hetu No. of Patients Percentage 1 Kshar sevan 380 68.46 2 Atiushna sevan 345 62.16 3 Atilavan 337 60.72 4 Viruddha anna sevan 184 33.15 5 Nispav 111 20 6 Udid sevan 284 51.17 7 Tila sevan 58 10.45 8 Vidagdha anna sevan 326 58.73

Figure 1 Aharaj hetu wise distribution

Table 2: Viharaja and Anya Hetu wise distribution

Sr. No Hetu No. of Patients Percentage 1 Diwaswap 301 54.23 2 Ativyayam 281 50.63 3 Vegdharan 131 23.60 4 Mansik karan 170 30.63 5 Mrudbhakshan 291 52.43

Figure 2: Viharaja and anya hetu wise distribution

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Table 3: Roop (Lakshanas) wise distribution Sr. No Lakshanas No. of Patients Percentage

1 Twak-Netra-Nakha Panduta 420 75.67 2 Kantihinata 105 18.91 3 Karnasweda 82 14.77 4 Agnimandya 290 52.25 5 Daurbalya 281 50.63 6 Angsad 295 53.15 7 Annadwesh 293 52.79 8 Bhram 162 29.18 9 Shram 104 18.73 10 Jwara 49 8.82 11 Shwas 151 27.20 12 Gaurav 95 17.11 13 Aruchi 72 12.97 14 Sarvangmard 322 58.01 15 Pindikodweshtan 298 53.69 16 Shool at Kati-sakti-pada 281 50.63 17 Keshpatan 329 59.27 18 Hrud-spandan 286 51.53 19 Akshi-kut shotha 306 55.13 20 Kopan 327 58.91 21 Alpawak 175 31.53 22 Atinidra 292 52.61 23 Sheetadwesha 135 24.32

Figure 3: Lakshanas wise distribution

Table 4: Proportion of two variables - Hetu and Lakshanas

Sr. No. Types of Pandu Statistical analysis -1.96 < Z < +1.96

Significant / Not Significant

1. Tridoshaj Pandu Z = 0.333 Significant 2. Vataj Pandu Z = -0.466 Significant 3. Pittaj Pandu Z = 0.303 Significant 4. Kaphaj Pandu Z = -0.188 Significant

As calculated Z € A.R. (Area of Regression) i.e. -1.96 < Z < +1.96 At 5% level of Significance on an average Proportion of Hetu and Lakshanas does not differ significantly

DISCUSSION Total 650 adolescent females were randomly taken for present study. Out of 650 females 555 females were having Hemoglobin percent between 5 to 10 gm percent. Study of 13 Hetus as well as 23 Lakshanas was included in present study from different Samhitas. Out of 13 Hetus 8 Hetus were found more than or equal to 50 percent. Out of 23 Lakshanas 13 symptoms were found more than or equal to 50 percent. In present study Kshar sevan, Atiushna, Atilavan, Udidsevan, Vidgdha-Anna, Diwaswap, Ativyayam, Mrud-Bhakshan hetus were found more than 50 percent of patients where as other hetus were less than 50 percent. Due to Hetu Sevana, Pitta Pradhana Tridosha gets vitiated and is circulated in the whole body causing shithilata in all dhatus which ultimately reduces Rasa-Rakta and Meda dhatu. Decrease in Sneha, along with Ras-Rakta

Dhaturupa Oja-Guna, Varna, Bala results in Pandu vyadhi1-4. The study shows that symptoms like Twak-Netra-Nakha Panduta, Agnimandya, Daurbalya, Angsad, Annadwesh, Sarvangmard, Pindikodweshtan, Shool at Kati-sakti-pada, Keshpatan, Hrud-spandan, Akshi-kut shotha, Kopan, Atinidra were found more than 50 percent of patients where as other symptoms were less than 50 percent. The diagnosis of Vyadhi can be done only when group of symptoms (i.e Lakshansamuha) is seen, because on the basis of one Lakshana Vyadhi Vinischaya is not possible. Out of 8 hetus (Table 1-2) which were found more than 50 percent, 5 Hetus i.e Ksharsevan, Atiushna, Atilavan, Virudha-anna, Diwaswap were found in more than 300 patients who were nearly about 60 percent. All these Hetus vitiates Vata, Pitta and kapha simultaneously hence causing Tridoshaj type of Pandu.

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Out of 13 symptoms (Table 3) which were found more than 50 percent, 5 symptoms i.e. Twak-netra-nakh Panduta, Keshpatan, Kopan, Sarvangmard, Akshikutshotha were found in more than 300 patients which were nearly about 60 percent. These symptoms reflect Vitiation of all the three Doshas. All 4 types of Pandu vyadhi assessed in this study, among which Tridoshaja Pandu were found in more than 50 percent of patients. As Hetus which are found more than 50 percent vitiates all the three Doshas. According to statistical analysis (Table 4) of proportion of two variables regarding Hetu and Lakshanas z value for Tridoshaja Pandu was 0.333, for Vataj Pandu was -0.466, for Pittaj pandu was 0.303 and for the Kaphaj Pandu was -0.188. All the values are in between -1.96 and +1.96 so the relation between Hetu and Lakshanas agrees with each other and they do not differ significantly hence the study is significant6.

CONCLUSION Survey study of Pandu vyadhi in slum area shows statistically significant result as- 555 Patients out of 650 were having Hemoglobin percent between 5 to 10 gm percent which have been enrolled in the present study. 300 patients out of 555, which is more than 50 percent shows 8 Hetus (out of 13) and 13 Symptoms (out of 23) which is again more than 50 percent and on statistical analysis Z value of two proportional means regarding Hetus and Lakshanas comes in between -1.96 and +1.96 (at 5 percent level of significance) so the result is significant6. Out of 4 types of Pandu in present study Tridoshaj pandu is found to be more than 50 percent (i.e 290 patients) while other are less than 50 percent so prevalence of Tridoshaja pandu is more in the area taken for the study.

ACKNOWLEDGEMENT By the grace of Bhagwan Dhanvantari, it is a great feeling of pleasure, pride and happiness to present this research article. There is hardly any task which is more pleasant than acknowledgement to pay my gratitude to all those who have helped in so many ways in preparing this work. I pay my sincere thanks to Co-Author, Dr. Yogini Kulkarni and Dr. Satyendrakumar Singh for their valuable help. I would like to express my profound gratitude and indebtedness to Honorable Dr. Rajendra Bobade, Vice Principal, H.O.D. Swasthvrutta Dept, Dr. Meenal D. Lad, Director, Post Graduate Studies, C. A. R. C. who always supported me during the study. I am overwhelming thankful to my departmental teachers Dr Ujwala Pawar, Dr Rajesh Mhaske, Mr. Sunil Todkar, Mrs. Chandratre for their kind co-operation and help. Lastly I would like to express my thanks to all of them who directly or indirectly have contributed to my Research article. REFERENCES 1. Vd. Joshi YG. Charaka Samhita Ayurveda Dipika commentary by

chakrapani, Marathi Bhashantar with Yashwant teeka: Vaidyamitra Prakashan, 1st edition 2003, Vol - 2, Cha. Chi. 16, Pg 380, Shloka 4-6.

2. Vd. Yadunandan Upadhyay, Sushruta Samhita: Nibandha Sangraha commentary by Dalhana, Chaukhamba Orientalia, Varanasi, 8th edition, Su. U. 44, Pg 729, Shloka 2-4

3. Vd. Bramhanand Tripathi, Ashtanga Hrudaya: Sarvangasundara commentary, Chaukhamba Surbharti prakashan, Varanasi, 6th edition, 2000 vol - 1, Adhyay 13, Shloka 4-6.

4. Madhava Nidana: Madhukosa Vyakhya and Hindi Comm. By Sudarshana Shastry Edited by Yadunandana Upadhyaya, Chaukhambha, Varanasi, Ma. Ni. Pandu, Pg 112.

5. Praful B. Godkar, Textbook of medical Laboratory Technology: Bhalani publishing House, Dadar, Mumbai, Routine Hematological Test, Pg 726.

6. Mahajan BK, Methods in Biostatistics: Jaypee broth. Medical Publisher (P) Ltd, New Delhi, 6th edition, Test of Significance.

7. Siddharth N. Shah, API Textbook of Medicine: 7th Edition 2003, Hematology.

8. Robbins, Pathologic Basis of Disease: Prisms Book, Bangalore. 1994, Hematology.

9. Websites: 25 Feb. 2012 www.google.co.in, www.wikipedia.org

Source of support: Nil, Conflict of interest: None Declared