Management of Pandu Opuntia Mill. (Nagaphani) Fruit Juice

J. res. tradit. med Sept - Oct 2016 Volume 2 Issue 5| | |

Original Article - Case Study

Website:www.tmjournal.org

Received:24/11/2016 Revised:21/12/2016 Accepted: 4/1/2017

Management of Pandu (Anaemia) with Opuntia elatior Mill. (Nagaphani) Fruit Juice - A

Folklore Plant 1 2Shashikant Prajapati*, Rabinarayan Acharya , Mandip Goyal

1 2*PhD Scholar, Professor, Department of Dravyaguna, Associate Professor, Department of Kayachikitsa, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.

Abstract

Keywords:

Introduction

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Haemoglobin, Iron deciency anaemia, Opuntia elatior, Pandu

Prajapati et al, Effect of Opuntia elatior Mill. (Nagaphani) fruit juice in Pandu.

Background: Pandu is a clinical condition characterized by pale discoloration of skin, sclera, nails etc. and occurs due to deciency of Rasa and Rakta Dhatu and the main line of treatment in Pandu is to improve their status. Panduroga can be compared with anaemia on the ground of its similarity in signs and symptoms. Nagaphani (Opuntia elatior Mill.) is a widely prevalent plant in the state of Gujarat and its fruits are traditionally used as a successful haematinics agent in general and to treat Pandu (anaemia) in particular. Aims: To evaluate the pharmacotherapeutic effect of the fruit of Opuntia elatior Mill. on Pandu (anaemia). Material & Methods: The present study was conducted upon a 44 year old male patient who was suffering from Daurbalya (general weakness), Panduta (pallor), Bhrama (vertigo), Pindikodweshtana (calf muscle cramp), Shrama (fatigue) and Shwasa (exertional dyspnoea) from one year with his haemoglobin value always below 10 gm% from last six months. The patient was administered with fruit juice of Opuntia elatior in the dose of 20 ml twice a day before meal for 60 days. Results: Opuntia elatior fruit provides marked effect in relieving classical symptoms of Pandu like Daurbalya, Panduta, Bhrama, Pindikodweshtana, Shrama, and Shwasa after two months of treatment and also increase in Hb%, TRBC count, Serum Iron and Serum ferritin was noted. Conclusion: The preliminary study conducted based on biochemical, hematological and clinical assessment showed haematinic effect of Opuntia elatior fruit juice in the management of Pandu with respect to iron deciency anemia which conrms the folklore claim, However well designed randomized clinical trails will be needed to analyze the exact efcacy of the drug.

Corresponding Author:Shashikant Prajapati,

PhD Scholar, Department of Dravyaguna, Institute for Post Graduate Teaching & Research in

Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.

Email: [email protected]

anduroga is a disease entity described in

PAyurveda which bears great resemblance to the [1] clinical picture of anaemia. It occurs due to

depletion of Rasadhatu which causes the improper production of Raktadhatu. Anaemia is a public health problem globally and a condition in which the number of red blood cells and consequently their oxygen-carrying capacity is insufcient to meet the body's

[2] physiological needs. World Health Organization estimates that 1.62 billion people globally are affected with anaemia which corresponds to 24.8% of the

[3]world population. Prevalence of anaemia in all the groups is higher in India as compared to other

[4]developing countries. In India, anaemia affects an [5]

estimated 50% of the population.

Many drugs are available in the modern science for combating anemia but they are costly and therefore out of reach of poor people who are the major sufferers

[6]of the ailment, moreover the allopathic drugs used to

treat anemia produce gastric irritation and have side effects like nausea, constipation, diarrhea etc. which

[7]further deteriorates the health of the patient. Thus, it is the need of time to use herbal drugs which are easily available, safe, effective and low in cost .

In Gujarat Opuntia elatior Mill, a member of Cactaceae family known as Nagaphani has been reported for its traditional uses in different disease conditions like

[8] anaemia, asthma etc. by the tribes. O. elatior possesses varied ethno-botanical claims in different diseases. In asthma baked fruits is administered internally once in a day for a week, pulp of ripe fruit is used in burning

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DOI:10.21276/jrtm.2016/273

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sensation in the stomach, fruits rst heated and then powdered from which about 5gm powder is

[9]consumed at morning in rheumatism. The plant O. elatior has reported various pharmacological activities such as haematinic, anti-inammatory, analgesic, anti-leukemic and anti-ulcer activity including its safety

[8] reports during acute toxic study. Hence the present study was aimed at evaluating the haematinic role of O. elatior in Pandu.

Materials and MethodsCase report A male patient aged about 44 years visited the outpatient department of Dravyaguna at Institute of Post Graduate Teaching and Research in Ayurveda, Hospital, Jamnagar, Gujarat, India (with Reg no. 9098) on May 09, 2015 with presenting complaints of Daurbalya (general weakness), Panduta (pallor), Pindikodwesthana (calf muscle cramp), Shrama (fatigue) and Shwasa (exertional dyspnoea) from 1 year. These symptoms had developed since 1 year and had slow progression. The patient initially developed pallor on face which later progressed to skin allover the body. On local examination pallor was found on the skin, face and nail region of the body. He did not have history of jaundice/liver disease/bleeding disorders/ DM/HTN/IHD, major surgical procedure or any history of trauma or drug abuse. He was investigated with haematological parameters like; Hb%, Total RBC, MCV, MCH, MCHC etc.) and biochemical parameters like; serum iron, serum ferritin, TIBC etc.) and diagnosed with anaemia.

Preparation of drugFreshly collected fruits of O. elatior were thoroughly washed with adequate amount of water and the bunch of thorn over the fruits were neatly plucked using forceps. Following this, the outer skin of fruits was removed and the remaining part of fruits was macerated and the resultant juice obtained was passed through sieve and ltered.

The residue consisted of the sludge and seeds were separated. The ltered juice was then preserved by addition of 1 gm sodium benzoate per one litre of

[10] juice. (gure: a - f)

Treatment givenO. elatior fruit juice (20ml) was administered twice daily to the patient. The medicine was given is empty stomach with lukewarm water as Anupana (vehicle) for 60 days. The changes in the sign and symptoms of Pandu were recorded.

Criteria for diagnosisEfcacy of the therapy was assessed on the basis of the following criteria.

Objective criteria: Laboratory investigations i.e. Hb%, TRBC count, MCV, MCH, MCHC, Serum iron, Serum ferritin, TIBC etc. Before and after treatment were considered as main assessment criteria.

Subjective criteria: Symptoms and signs of Panduroga described in Ayurvedic classics were taken as subjective criteria. Score adopted for the main signs and symptoms was based on WHO – guidelines for

[11]clinical research methodology in Ayurveda.

To assess the effect of drug; changes in the signs and symptoms were examined at regular interval of a week and recorded in the clinical research proforma. To give results objectively, multidimensional scoring pattern was adopted. This score was obtained before and after the treatment to assess the efcacy of therapy. Score was given according to the severity of symptoms. (0 - Absence of symptoms, 1 - Mild degree of symptoms, 2 - Moderate degree of symptoms, 3 - Severe degree of symptoms, 4 - Very severities of symptoms).

ResultsAssessment was done on the basis cardinal symptoms

thof Pandu before treatment and at very 15 day of treatment schedule. The gradations of the symptoms during treatment days are shown in tables 1.

Table 1: Assessment on subjective parameters

Symptoms BT 15D 30D 45D AT

Panduta (pallor) 4 4 3 2 1 Daurbalya (general weakness) 3 3 2 1 1 Akshikutashotha (periorbital oedema) 3 3 2 2 1 Hridspandana (palpitation) 2 2 2 1 1 Shiroruja and Shotha (headache and Oedema) 2 1 1 1 1 Pindikodweshtana (calf muscle cramp) 4 3 2 1 0 Shrama (fatigue) 3 2 2 1 0 Shwasa (exertional dyspnoea) 2 2 2 1 1



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Fig a: Natural Habitat of Nagaphani Fig b: Collection of Nagaphani fruits

Fig c: Nagaphani fruits Fig d: Removing thorn from Nagaphani fruits

Fig e: Preparing Swarasa from Nagaphani fruits Fig f: Swarasa of Nagaphani fruits

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In all the classical symptoms of Pandu, improvement was found during treatment period. Assessment on haematological and biochemical parameters before and after treatment are noted down in table 2 & 3.

DiscussionVitiated Pitta & Vata are the major aetiological factors of Pandu. Tikshnata (sharpness) of Pitta & Rukshata (dryness) of Vata results in decrease of Sarata (nal

[10]product) of Rasa and Rakta Dhatu. O. elatior possess [12]

Madhura and Kashaya Rasa which normalizes Pitta function and also has Madhura Vipaka which increase Sarata of Rasa Dhatu. This further leads to correction of the physiological function of Ranjaka Pitta in particular which then facilitates the normalcy of Rakta Dhatu formation. Normal Rasa Dhatu along with the Paittika

[13]elements is responsible for normal skin colour and useful in the management of Pandu.

Increase in Hb% was observed in the patient treated, which suggests the haematinic effect of O. elatior. A total iron binding capacity (TIBC) test is a type of blood test that gauges whether there's too much or too little iron in your bloodstream. It is the measures of blood capacity to bind iron with transferrin and used in the

[14]screening of iron deciency anaemia. The liver produces more transferrin, presumably attempting to

[15]maximize use of the little iron that is available.

In this case, decrease was observed in TIBC suggestive the role of O. elatior juice in iron deciency anaemia. As TIBC is closely related with liver, we can probably state that O. elatior has a promising role in Raktavaha Srotasa derangement especially in Ranjak Pitta. Rakta Dushti has been stated as a causative factor of

[16]Panduroga by Acharya Sushruta. Increase was observed in Serum iron & Serum ferritin. An increase in both these parameters ensures the role of O. elatior in iron deciency anaemia. O. elatior possess a signicant

[17] [18]haematinic & anti-oxidant activity. Presence of [19]

iron and ascorbic acid (vitamin C) in O. elatior, which reduces ferric iron to ferrous iron which remains soluble even at neutral pH and is better absorbed. Even when the diet is poor in iron, Vitamin C supplement with each meal enhances i ron

[20]absorption.

Thus it can be understood that O. elatior possesses a promising role in management of anaemia especially Iron deciency anaemia. Its mode of action in modern parlance correlates with the Raktavardhaka property in Ayurveda probably by enhancing the normal physiological functions of vitiated Pitta Dosha and promoting normal development of Raktadhatu by Ranjana of Rasadhatu.

ConclusionIt can be concluded by analyzing the results of the preliminary work that Opuntia elatior fruit juice has shown effectiveness in management of Panduroga, which helps in validating the folklore claim. It is a safe, economical and possess the potential to cure the disease. This case study demonstrates that the management is not only useful in anaemia but also improve the quality life of parameters.

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Table 2: Assessment on haematological parameters

Investigation B.T A.T

Hb (gm %) 9.1 11.4 TC (/Cumm) 6000 6000 DC

N% 60 55 L% 36 41 E% 01 01 M% 03 03

T RBC (mil / cumm) 5.22 5.34 ESR (mm/hr) 28 04 MCV (fl) 60.3 66.5 MCH (Pg) 17.4 21.3 MCHC (gm/dl) 28.9 32.1 PCV (%) 31.5 35.5 Platelet count (103/ul) 486 299

Table 3: Assessment on bio-chemical parameters

Investigation B. T. A. T.

S. Ferritin 5.3 5.6 S. Iron (mg/dl) 64 90 TIBC (mg/dl) 387 380 S. creatinine (mg/dl) 1.0 0.9 Blood urea (mg/dl) 23 21 S. G. P. T. (IU/L) 11 11 S. G. O. T (IU/L) 24 20 Blood sugar (F/R) (mg/dl) 125 111


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How to Cite the article:Shashikant Prajapati, Rabinarayan Acharya, Mandip Goyal. Management of Pandu (Anaemia) with Opuntia elatior Mill. (Nagaphani) fruit juice - A folklore plant. J. Res. Tradit. Med 2016; 2(5): 151-155http:dx.doi.org/10.21276/jrtm.2016/273

Source of Support: IPGT & RA, Gujarat Ayurved University, Jamnagar

Conict of Interest: NIL


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Management of Pandu Opuntia Mill. (Nagaphani) Fruit Juice