|Year : 2013 | Volume
| Issue : 2 | Page : 184-188
Clinical Efficacy of Panchakola on Raktakshaya
Kishor G Satani1, Hitesh A Vyas2, Mahesh K Vyas3
1 Lecturer, Department of Basic Principles, J. S. Ayurveda College, Nadiad, India
2 Assistant Professor, Department of Basic Principles, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
3 Associate Professor, Department of Basic Principles, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
|Date of Web Publication||10-Oct-2013|
Kishor G Satani
Block No. 5, Mamtapark Society, Street No.-3, Spinning Mill, L.H. Rd, Surat - 395 006, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Rakta is considered to be the cause of the origin, maintenance and the destruction of the body. It may be correlated with blood tissue of modern science on the basis of similarities described in both the sciences and so, Raktakshaya can be correlated with anemia. The statistical figure shows that more than 50% of Indian population is affected by anemia. Because of Jatharagnimandya, Rakta Dhatvagni gets disturbed and leads to Raktakshaya. Current study was carried out on 46 patients of Raktakshaya. Patients were divided into two groups with simple random sampling method. Group A was treated with the Panchakola tablet while Group B was considered as placebo group and was given rice powder tablet. Duration of the treatment was 6 weeks. Classical Ayurvedic signs and symptoms of Raktakshaya with hematological parameters like hemoglobin (Hb), serum total iron binding capacity (S.TIBC), serum iron, serum ferittin level and blood indices were studied before and after treatment. Group A showed statistically highly significant increase in Hb g% and significant increase in other subjective and objective parameters.
Keywords: Raktakshaya, Panchakola tablet, Anemia
|How to cite this article:|
Satani KG, Vyas HA, Vyas MK. Clinical Efficacy of Panchakola on Raktakshaya. AYU 2013;34:184-8
| Introduction|| |
Rakta is accepted to be the cause of survival.  It is considered to be the cause of the origin, maintenance and the destruction of the body. Hence, it has been quoted under the Pranayatana as well as Mula of the living body. It is also known as Jiva and Oja which indicates its importance; its Kshaya or diminutions have a great threat to the survival of the human being. Raktakshaya is a common condition and signs and symptoms of it can easily be identified. Classical signs and symptoms of Raktakshaya like Amlashita Prarthana, Twak Rukshata, Glani, Panduta can be covered under the big umbrella of Panduroga. Acharya Charaka and Sushruta have clearly mentioned that the vitiation of doshas causes Rakta dushti and thereby, Twak becomes pale in color. Acharya Harita clearly indicate decreased blood volume by "Nayati Rudhirashoshana0"  in Panduroga. Same way, Chakrapanidatta mentioned that Raktakshaya develops due to the diminution of the Rasa by the increased Pitta or the failure of the Rasa to produce the Rakta poshaka part.  In this way, having resemblance with anemia, Raktakshaya can be correlated with anemia.  The statistical figure shows that anemia affects an estimated 50% of the population in India.  The prevalence of anemia is slightly higher in younger women less than 25 years of age than in older women and for women who are unmarried than married women. It is considerably higher for rural women (54%) than for urban women (46%) and so, looking towards its prevalence, it is included in national health programme of India.  Raktakshaya may be observed as a symptom or an individual disease. As a symptom, it is observed mainly in chronic diseases and external or internal bleeding and it is manifested as an individual disease due to impairment of Raktadhatvagni. Poor supplementation of Iron is also one of the major causes for Raktakshaya, Raktakshaya can also occur due to inadequate absorption or utilization of Iron which can be understood in the terms of Agnimandya in Ayurveda.  In current study, patients affected by Raktakshaya due to impairment of Raktadhatvagni were selected and improvement in classical signs and symptoms of Raktakshaya and Agnimandya were assessed. This study was aimed to evaluate the interrelationship between Jatharagni and Dhatvagni as; moieties of Kayagni, located in its own place, are distributed to and permeate to all Dhatus. A decrease of it (below the normal) makes for an increase of Dhatus while an increase of it (above the normal) makes for a decrease of Dhatus.  Hence, a drug, Panchakola having Dipana property has been selected as trial drug for the present study. 
| Materials and Methods|| |
Preparation of drug
Panchakola Churna and its tablets were prepared in the Pharmacy, Gujarat Ayurved University (GAU), Jamnagar. Pharmacognosy and Analytical study were carried out in the Pharmacognosy laboratory and Pharmaceutical chemistry laboratory of Institute for Post Graduate Teaching and Research in Ayurveda respectively. Pippali (Piper longum Linn.), Pippalimula (Root of the Piper longum Linn.),  Chavya (Piper chaba Hunter),  Chitraka (Plumbago zeylanica Linn.)  and Sunthi (Zingiber officinale Roscoe)  are the ingredients of Panchakola Churna [Table 1]. The tablets were given to the patients during samana kala middle of a meal. 
Source of data
Total 46 patients of Raktakshaya attending outpatient department (OPD) of Basic Principles department, IPGT and RA, GAU, Jamnagar were registered. Classical signs and symptoms of Raktakshaya, Hb percentage and blood indices were taken into consideration as criteria of assessment. S. Iron, S. ferittin and S.TIBC were also carried out for treated group patients.
Patients of age between 20 to 60 years presenting with clinical features of Raktakshaya like Amlashita Prarthana (craving for sour and cold), Twak Parushya (roughness of the skin), Sira Shaithilya (loss of the tone of the Sira), Agnimandya (diminished appetite), Daurbalya (weakness), Bhrama (giddiness), Alpayasena Shwasakashtata (exertional dyspnea) manifested due to hypo functioning of Agni and having Hb value in between the range of 6 and 11.5 gm% with age in between 20 and 60 years were selected for study.
Raktakshaya of external origin or internal bleeding disorders (Srava-janya), individuals suffering from genetic diseases, all types of secondary anemias, patients having Hb <6 g/dl, pregnant and lactating women were excluded from the study.
The study was cleared by the ethics committee of the Institute. Written consent was taken from each patient willing to participate before the starting of the study. Patients were free to withdraw their name from the study at any time without giving any reason.
All the selected patients were randomly divided into two groups by simple random sampling method.
Group A was treated with Panchakola tablet (treatment group) and in Group B rice powder tablet (placebo group) was administered. 26 patients were registered in Group A and 20 in Group B. Total 22 patients had completed the course of treatment in Group A, whereas 18 patients completed in Group B.
Four tablets of Panchkola and placebo (500mg each), 3 times middle of a meal for 6 weeks along with water as Anupana was given in both the groups.
An assessment was made on change in clinical feature before and AT. The scoring was given to each symptom ranging from 0 to 3.
Overall effect of therapy
To evaluate the overall effect of therapy, first percentage of improvement in each scale is calculated for each patient. Then, an average improvement of each patient is drawn. Total percentage in each category is calculated and presented. Total number of patients are grouped into no change (0-25%), mild improvement (26-50%), moderate improvement (51-75%), marked improvement (76-99%) and complete remission (100%). Later Student's paired t-test is applied on above data and final conclusion is drawn.
Patients were advised to avoid heavy diet, contrary foods or stale foods, cold water and sleeping after eating again and again, suppression of natural urges, psychological stress and strain, not to eat before digestion of previously taken food. 
The obtained data of observations were analyzed by the Student's paired t-test.  (conceded at the level of P < 0.001 as highly significant, P < 0.05 or P < 0.01 as significant and P < 0.10, P > 0.01, P > 0.05 as insignificant).
| Observations and Results|| |
Total 46 patients were registered in the present study. Majority of the patients, (50%) were in the age group of 30-39 years. Majority (84.78%) of the patients were females, 56.52% patients had primary education and 52.17% patients were from lower economy group.
In Group A, statistically significant results were found in Amla Prarthana (61.90%), Agnimandya (61.11%), Daurbalya (50%), Panduta (30%), Twak Parushya (66.67%), Sira Shaithilya (60%), Abhyavaharana Shakti (63.13%), Udgara Shuddhi (59.22%), Annashraddha (59.91%), Klama Parigamana (46%) [Table 2].
|Table 2: Effect of Panchakola tablet on cardinal symptoms of Raktakshaya|
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In Group A, statistically significant results were found in objective parameters like; improvement in Hb value was observed by 16.22% and total red blood corpuscular count (57.51%), S.TIBC (6.15%), S. Iron (4.17%), S. ferittin (2.51%) was found [Table 3]. Total improvement observed in Group A (68.42%) was statistically highly significant, while, it was statistically insignificant in Group B with only 26.38% improvement [Table 4]. In Group B, statistically significant results were found in Daurbalya (38.24%), Panduta (74.71%), Tamo Darshana (55.55%) and Hrida Spandanadhikya (65.36%).
|Table 3: Effect of Panchakola tablet on hematological parameters in patients of Raktakshaya|
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Rest of all features of Raktakshaya and hematological parameters were remained statistically insignificant [Table 3].
In Group A, 12.70% patients had complete remission, followed by 59.18% marked improvement, 14.64% moderate improvement and 9.06% patients had mild improvement. Whereas, in Group B, 16.12% had marked improvement, mild improvement in 22.24%, 18.78% of total patients remained unchanged [Table 5].
| Discussion|| |
Raktakshaya is one of the important health issues in India. Among various causes of the ailment, malnutrition is at prime place. More than 50% of Indian population is affected by this disease. Because of this it is included in the national health program. Many of the patients attending the OPD of any health institute for any disorder found to be anemic. One of the important causes of the disease is poor metabolism and utilization of iron for production of Hb. 
Hypothetically it can be said that improvisation of the Jatharagni and Dhatvagni would be useful in this condition.
In the present study, majority of patients were having age group of 30-39 years. A maximum of 84.78% female patients were found in this group. Particularly, females of this age are prone for maximum psychological stress, and have to concentrate on their families due to which proper nutritional diet or even regularity to take the diet may be ignored that manifests Raktakshaya through hypo functioning of Agni. Maximum patients of this study were from lower income group and also having age of 20-40 years.
56.52% patients had primary education. Because of lack of education people were found unaware to the seriousness of the problem and were not following the instructions of their family doctors to have nutritious food or food supplements. Because of low income they were unable to spend money for medicines or food supplements and so, Raktakshaya was found maximum in those patients. Maximum patients (32.61%) had Kapha-Vata Prakriti. Both of these Doshas have nature to vitiate Agni either to Manda state or to Vishama state. As both of these states are abnormal, digestion and absorption of food cannot be done properly.
Due to improper function of Jatharagni, Dhatvagnis get vitiated which results in decrease of Dhatu. 69.48% patients had Avara Abhyavaharana Shakti, 67.79% patients had Avara Jarana Shakti, 71.74% patients were observed to have the habit of Atiguru Bhojana, 65.22% of the total patients were habitual to take Atisnigdha Bhojana to be the etiological factors of disease Raktakshaya due to Jatharagnimandya.
Though the given treatment was not directly affecting the Raktadhatu, Group A patients show statistically significant improvement in maximum symptoms of Raktakshaya. This proves the hypothesis that improvement in Jatharagni helps in correcting Dhatvagni and on this line increase, decrease or vitiation of Dhatus can be managed. Significant increase of Hb without giving any iron contained medicine also helps the hypothesis. This proves that corrected Dhatvagni converts and combines available iron for the synthesis of Hb effectively. S.TIBC was found significantly increased in treated group, which means in these patients' secretion of transferrine has been increased significantly. According to modern patho-physiology, this may be interpreted in terms of anemia, particularly due to inadequate supply of iron but according to the Agni principle this indicates increase of Rakta Dhatvagni as due to increased transferrine iron can be combined and converted into Hb effectively.  This also can be understood in terms of Raktadhatu Utpatti and Poshana.
The mode of action of the drugs under trial can be understood on the basis of inherent properties of the individual components. All the ingredients of Panchakola have Laghu, Ruksha and Sukshma Gunas, Ushna Virya, Katu Rasa, Katu Vipaka and Pachana, Kaphahara properties. Rasa and Vipaka of the Panchakola are Katu, helpful in Agnidipana, Pachana. Thus, it becomes clear that Dipana drugs correct Agnimandya and after the ignition of Jatharagni; Amshas of it located in Dhatvashayas also ignited by Jatharagni. After the proper channelization of Rasadi Dhatu Samvahana, Raktakshaya can be treated. Thus, on the basis of clinical observations it can be said that ignition of Jatharagni with Dipana dravyas have their effect on Dhatvagnis too. This again validates the statement of Vagbhata that Dhatvagnis are the Amsha of Jatharagni.
Explanation for discontinuation
In the placebo group, application of rice flour powder tablet didn't give significant improvement was the cause of discontinuation of two patients. In the treatment group, two patients not willing to give a blood sample after 6 weeks of medicine. Therefore, they are considered as discontinued. No feedback available in other as they didn't visit OPD after discontinuation.
Therapeutic untoward effect
In treated group, three patients had complained burning sensation in chest after taking the medicine for a period of one week. Among them, two had Pitta Prakriti and all these patients had taken the Panchakola tablets on empty stomach. After consuming the medicine in between the food, the complaints were subsided.
| Conclusions|| |
Jatharagni and Dhatvagnis have a definite interrelationship. Panchakola Churna shows significant improvement in subjective and objective parameters of Raktakshaya. There was no iron contained medicine given to the patients in this study so, it can be concluded that if Panchakola Churna would be given before or with iron medicine may show better effect.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]