Panduroga, Kamala, Kumbhakamala And Halimaka Nidana – 8th Chapter Of Madhava Nidana

Introduction

The ancient science of Ayurveda provides all the knowledge about diseases on the basis of concepts of Dosha, Dhatu, Mala and Agni . Among the diseases mentioned in classic Ayurvedic texts, Panduroga, Kamala, Kumbhakamala and Halimaka are some of the disorders that arise with changes in normal body pigmentation and the imbalance of Pitta Dosha and dysfunction of the physiological function of Rakta Dhatu. These diseases are well studied in one of the classic Ayurvedic text called Madhava Nidana written by Madhavakara, where the Nidana (causative factors), Purvarupa (premonitory symptoms), Rupa (symptoms) and Samprapti (pathogenesis) of different diseases are explained in detail. Panduroga is mainly marked with Panduta or the whitening of skin and other tissues in the body while Kamala is marked mainly with yellowness in the body skin, eyes and other tissues in the body due to vitiation of Pitta and Rakta. Kumbhakamala is seen as a severe form of Kamala. Halimaka is another clinically important disease which is marked with greenish yellow or dark yellow color and involves vitiated Pitta and Vata.. A critical review of these classical descriptions helps establish a conceptual foundation for the diagnosis and differentiation of these conditions and facilitates a better understanding of their significance in contemporary Ayurvedic clinical practice.

Panduroga, Kamala, Kumbhakamala And Halimaka Nidana – 8th Chapter Of Madhava Nidana

Types Of Pandu Roga

पाण्डुरोगाः स्मृताः पञ्च वातपित्तकफैस्त्रयः।
चतुर्थः सन्निपातेन पञ्चमो भक्षणान्मृदः॥१॥ (Madhava Nidana Chapter 8, Shloka 1)

Vataja Pandu: A type of Pandu Roga resulting from the aggravation and predominance of Vata Dosha.
Pittaja Pandu: A type of Pandu Roga caused by the vitiation and predominance of Pitta Dosha.
Kaphaja Pandu: A type of Pandu Roga arising due to the aggravation and predominance of Kapha Dosha.
Sannipataja Pandu: A type of Pandu Roga caused by the simultaneous aggravation of all the three Doshas i.e. Vata, Pitta and Kapha.
Mridbhakshanajanya Pandu: A type of Pandu Roga associated with the habitual ingestion of soil or clay (Mridbhakshana).

Nidana Of Panduroga

व्यवायमम्लं लवणानि मद्यं मृदं दिवास्वप्नमतीव तीक्ष्णम्।
निषेव्यमाणस्य विदूष्य रक्तं दोषास्त्वचं पाण्डुरतां नयन्ति॥ २॥ (Madhava Nidana Chapter 8, Shloka 2)

Indulgence in excessive sexual activity (Vyavaya), intake of sour (Amla) and salty (Lavana) foods, alcoholic drinks (Madya), eating of soil (Mridbhakshana), sleeping during day time (Divaswapna), and intake of too spicy (Atiteekshna) foods vitiate the Doshas and Rakta Dhatu resulting in pallor or discoloration of skin.

Panduroga Purvarupa

त्वक्स्फोटनं ष्ठीवनं गात्रसादो मृद्भक्षणेच्छा करपादशोथः।
वर्णस्य भेदोऽरुचिरल्पवह्निः पूर्वरूपाणि पाण्ड्वामयस्य॥३॥ (Madhava Nidana Chapter 8, Shloka 3)

This Shloka refers to the Purvarupas or premonitory symptoms that precede the full development of Panduroga. Some of the premonitory symptoms are seen in the form of change in the color of the skin, excess spitting, weakness of the body, craving for mud, swelling of the hands and feet, change in the natural body complexion, loss of appetite, and poor digestion capacity. This is an indication of some sort of imbalance in the functioning of Doshas and Dhatus leading to Panduroga.

Vataja Pandu Lakshana (Signs And Symptoms)

त्वङ्मूत्रनयनादीनां रूक्षकृष्णारुणाभताः।
वातपाण्ड्वामये तोदकम्पानाहभ्रमादयः॥ ४॥ (Madhava Nidana Chapter 8, Shloka 4)

As per Madhava Nidana, the symptoms of Vataja Pandu are dryness and a blackish to reddish-brown coloring of the skin, urine, eyes, and various body parts. The clinical symptoms are as follows: Toda (stabbing pain), Kampa (tremors), Anaha (distention of abdomen because of inability to release flatus), and Brahma (dizziness or vertigo). All these symptoms are caused due to an increase in the Vata Dosha.

Pittaja Pandu Lakshana (Signs And Symptoms)

पीतमूत्रशकृन्नेत्रो दाहतृष्णाज्वरान्वितः।
भिन्नविट्कोऽतिपीताभः पित्तपाण्ड्वामयी नरः॥ ५॥ (Madhava Nidana Chapter 8, Shloka 5)

The following are the symptoms of Pittaja Pandu according to Madhava Nidana. There are yellow discolourations of urine, stool, and eyes along with Daha (burning sensation), Trishna (excessive thirst) and Jwara (fever). Other symptoms include loose motion (Bhinna Vit) and intense yellow discoloration of the body (Atipitabha). All of these symptoms develop because of the vitiation of the Pitta dosha that affects the proper functioning of the tissues of the body.

Kaphaja Pandu Lakshana (Signs And Symptoms)

कफप्रसेकश्वयथुतन्द्रालस्यातिगौरवैः।
पाण्डुरोगः कफाच्छुक्लैस्त्वङ्‌मूत्रनयनाननैः ॥ ६ ॥ (Madhava Nidana Chapter 8, Shloka 6)

According to Madhava Nidana, Kaphaja Pandu is characterized by excessive salivation (Kapha Praseka), swelling of the body (Shvayathu), drowsiness (Tandra), laziness or lack of activity (Alasya), and excessive heaviness of the body (Ati Gaurava). The person may also show a whitish discoloration of the skin (Shukla Tvak), urine (Shukla Mutra), eyes (Shukla Nayana), and face (Shukla Anana). These symptoms are described as manifestations of the predominance of Kapha Dosha in Kaphaja Pandu.

Tridoshaja Pandu Lakshana (Signs And Symptoms)

ज्वरारोचकहृल्लासच्छर्दितृष्णाक्लमान्वितः ।
पाण्डुरोगी त्रिभिर्दोषैस्त्याज्यः क्षीणो हतेन्द्रियः ॥ ७ ॥ (Madhava Nidana Chapter 8, Shloka 7)

Tridoshaja Pandu is characterized by fever, loss of appetite, nausea, vomiting, excessive thirst, fatigue, weakness and reduced functioning of the sense organs. Since all three Doshas are involved, it combines the symptoms of Vataja, Pittaja and Kaphaja Pandu. Madhava Nidana describes this condition as Asadhya, meaning difficult or incurable according to the classical Ayurvedic prognosis.

Mrid Bhakshana Janya Pandu

मृत्तिकादनशीलस्य कुप्यत्यन्यतमो मलः।
कषाया मारुतं, पित्तमूषरा, मधुरा कफम् ॥ ८ ॥
कोपयेन्मृद्रसादींश्च रौक्ष्याद् भुक्तं च रुक्षयेत्।
पूरयत्यविपक्वैव स्रोतांसि निरुणद्ध्यपि ॥ ९ ॥
इन्द्रियाणां बलं हत्वा तेजो वीर्यौजसी तथा।
पाण्डुरोगं करोत्याशु बलवर्णाग्निनाशनम् ॥ १० ॥ (Madhava Nidana Chapter 8, Shloka 8-10)

It explains that a person who habitually eats soil or clay may develop an imbalance of the Doshas. The soil having astringent taste aggravates Vata, the soil having alkaline taste aggravates Pitta, the soil having sweet taste aggravates Kapha.The qualities of the soil can also disturb the normal functioning of the body tissues, cause dryness, and obstruct the body channels (Srotas). As a result, the strength of the sense organs, bodily energy (Tejas), vitality (Virya) and Ojas may decrease, leading to Pandu Roga. This condition is described as causing a loss of strength, normal complexion and digestive power (Agni).

Mrid Bhakshana Janya Pandu Lakshana

शूनाक्षिकूटगण्डभ्रूः शूनपान्नाभिमेहनः।
क्रिमिकोष्टोऽतिसार्येत मलं सासृक्कफान्वितम् ॥ ११ ॥ (Madhava Nidana Chapter 8, Shloka 11)

A person suffering from Mrid Bhakshana Janya Pandu may develop swelling around the eye sockets, temples, cheeks and eyebrows. Swelling may also occur in the feet, umbilical region and genital organs. Intestinal worms may be present, and the person may experience diarrhoea with stool containing blood and mucus.

Panduroga – Sadhya – Asadhyata

पाण्डुरोगश्चिरोत्पन्नः खरीभूतो न सिद्ध्यति ।
कालप्रकर्षाच्छूनाङ्गो यो वा पीतानि पश्यति ॥ १२॥
बद्धाल्पविट् सहारितं सकफं योऽतिसार्यते ।
दीनः श्वेतातिदिग्धाङ्गश्छर्दिमूर्च्छातृषान्वितः ॥ १३॥ (Madhava Nidana Chapter 8, Shloka 12-13)

Chronic and severe Panduroga is considered incurable. Similarly, a patient who develops swelling of the body due to prolonged disease or who sees objects as yellow has an unfavourable prognosis. A patient with Panduroga who initially passes scanty, constipated stools and then develops diarrhoea with greenish, mucus-containing stools, severe weakness, marked pallor, vomiting, fainting and excessive thirst is considered to have a grave prognosis.

Asadhya Lakshanas Of Panduroga

स नास्त्यसृक्क्षयाद्यस्तु पाण्डुः श्वेतत्वमाप्नुयात् ।
पाण्डुदन्तनखो यस्तु पाण्डुनेत्रश्च यो भवेत् ॥
पाण्डुसङ्घातदर्शी च पाण्डुरोगी विनश्यति ।१४॥
अन्तेषु शूनं परिहीनमध्यं म्लानं तथा तेषु च मध्यशूनम् ॥
गुदे च शोफस्यथ मुष्कयोश्च शूनं प्रताम्यं तमसंज्ञकल्पम् ।
विवर्जयेत्पाण्डुकिनं यशोर्थी तथातिसारज्वरपीडितं च ॥१५॥ (Madhava Nidana Chapter 8, Shloka 14-15)

A patient with Panduroga who develops severe pallor associated with blood depletion, along with abnormal pallor of the teeth, nails and eyes, has an unfavourable prognosis.: A patient with Panduroga who experiences abnormal pale-coloured visual perceptions and develops a combination of swelling at the extremities with wasting or weakness of the central body, or the reverse pattern of swelling, is described as having a grave prognosis.

Kamala Roga: Nidana And Samprapti

पाण्डुरोगी तु योऽत्यर्थं पित्तलानि निषेवते।
तस्य पित्तमसृङ्मांसं दग्ध्वा रोगाय कल्पते॥ १६॥
हारिद्रनेत्रः स बृशं हारिद्रत्वङ्गनखाननः।
रक्तपीतशकृन्मूत्रो भेकवर्णो हतेन्द्रियः॥ १७॥
दाहाविपाकदौर्बल्यसदनारुचिकर्षिता।
कामला बहुपित्तैषा कोष्ठशाखाश्रया मता॥ १८॥ (Madhava Nidana Chapter 8, Shloka 16-18)

If a person with Panduroga eats too much Pitta increasing food, then Pitta increases. This Pitta affects blood (Rakta) and muscles (Mamsa) leading to Kamala Roga.The skin, eyes, nails and face of the patient turn yellow. The urine and stool show abnormal yellowish or reddish yellow coloration. The complexion may resemble that of a frog, and the senses become obtuse.Kamala is a disease of predominant pitta. The patient complains of burning sensation (Daha), indigestion (Avipaka), weakness (Daurbalya), exhaustion (Sadana) and loss of appetite (Aruchi). In the disease, the Koshtha (internal part i.e. gastrointestinal region) and Shakha (peripheral tissues) are involved.

Symptoms Of Kumbha Kamala

कालान्तरात् खरीभूता कृच्छ्रा स्यात् कुम्भकामला।

Kumbha Kamala is a chronic, severe and advanced stage of Kamala (Ayurvedic jaundice) in which the disease becomes deeply rooted and difficult to treat

Asadhya Lakshana Of Kamala

कृष्णा-पीतशकृन्मूत्रो बृशं शूनश्च मानवः ॥ १९ ॥
सरक्ताक्षि-मुख-च्छर्दि विण्मूत्रो यश्च ताम्यति ।
दाहारुचि-तृडानाह-तन्द्रा-मोह-समन्वितः ॥
नष्टाग्निसंज्ञः क्षिप्रं हि कामलावान् विपद्यते ॥ २० ॥ (Madhava Nidana Chapter 8, Shloka 19-20)

These are warning signs that indicate a severe or advanced stage of Kamala, suggesting a poor prognosis. According to Ayurvedic principles, when the disease becomes severe, the Doshas are highly aggravated, and the patient’s strength is greatly reduced, treatment becomes difficult.

Asadhya Lakshana Of Kumbha Kamala

छर्द्यरोचकहृल्लासज्वरक्लमनिपीडितः ।
नश्यति श्वासकासार्त्तो विड्भेदी कुम्भकामली ॥ २१॥ (Madhava Nidana Chapter 8, Shloka 21)

A patient suffering from Kumbha Kamala who has vomiting, loss of appetite, nausea, fever, severe tiredness, breathlessness, cough and diarrhoea has a grave prognosis.

Halimaka Symptoms

यदा तु पाण्डोर्वर्णः स्याद्धरितः श्याव-पीतकः ॥ २२ ॥
बलोत्साहक्षयस्तन्द्रा मन्दाग्नित्वं मृदुज्वरः ।
स्त्रीष्वहर्षोऽङ्गमर्दश्च दाहस्तृष्णा अरुचिर्भ्रमः ॥
हलीमकं तदा तस्य विद्यात् अनिलपित्ततः ॥ २३ ॥ (Madhava Nidana Chapter 8, Shloka 22-23)

Halimaka is characterized by greenish or dark-yellow discoloration of the body, weakness, lack of enthusiasm, drowsiness, poor digestion, mild fever, reduced sexual desire, body aches, burning sensation, excessive thirst, loss of appetite and dizziness. It is caused by the aggravation of Vāta and Pitta Doshas.

Symptoms Of Panaki

सन्तापो बहुमूत्रत्वं बहिर्भिश्च पीतता ।
पाण्डुता नेत्रयोश्चैव पानकीलिङ्गमुच्यते ॥

Panaki is characterized by fever or a feeling of heat in the body (Santapa), frequent urination (Bahumutratva), yellowish discoloration of the body (Pitata), and paleness or yellowish discoloration of the eyes (Paṇḍuta netrayoḥ). In simple words, the person may feel hot or feverish, pass urine frequently, and develop yellowish body discoloration and changes in eye colour.

Conclusion

Madhava Nidana gives a systematic and useful understanding of Paṇḍuroga, Kamala, Kumbhakamala and Halimaka on the basis of their characteristic signs, symptoms and underlying Dosha involvement. These conditions underline the importance of careful clinical observation, early identification of disease manifestations and comprehending their evolution according to the principles of Ayurveda. The descriptions given in this classical text are still an important basis for the study of Ayurvedic diagnosis and pathogenesis. An extensive knowledge of these disorders enables students and practitioners to understand the significance of Nidāna in clinical assessment and stimulates a more thorough investigation of their management within the framework of classical Ayurvedic knowledge